Evaluating Surgical Trends and Outcomes in Stress Urinary Incontinence: A Clinical Audit at a District General Hospital.

Abstract

Stress urinary incontinence (SUI) significantly impairs quality of life. This retrospective audit aimed to evaluate surgical treatment patterns and outcomes for SUI at a district general hospital between 2018 and 2023 and to compare them with national benchmarks from the third British Society of Urogynaecology (BSUG) report in 2020-21. Data from 99 patients were collected from the BSUG database and hospital electronic records, following clinical audit department approval. The mean age of patients undergoing surgery was 50 years. In 2018, mid-urethral tape was the most commonly performed procedure (46.2%); however, following the UK-wide suspension of vaginal mesh procedures that year, there was a notable shift towards alternative surgeries. Bladder neck injections (BNIs), colposuspension (open and laparoscopic), and autologous fascial sling (AFS) procedures all increased in frequency, mirroring national trends. BNIs became the predominant procedure, accounting for 76.8% of cases, with over 80% performed on an outpatient basis. Reported cure rates, when compared to national figures, were AFS (100% vs. 94%), laparoscopic colposuspension (71.4% vs. 84%), BNIs (66% vs. 60%), and open colposuspension (33.3% vs. 81%). Bladder injuries occurred in 17.3% of colposuspension cases, significantly higher than the national average of 2.7%. Additionally, prolonged catheterisation (>10 days) was noted in 29% of colposuspension cases, compared to 7.1% nationally. These elevated complication rates may reflect the procedural learning curve, as laparoscopic colposuspension was only recently introduced at the center. The audit highlights evolving surgical trends and outcomes in the management of SUI following the national mesh pause, with a shift toward non-mesh alternatives. Further audits with long-term follow-up and larger sample sizes are recommended to assess the safety, efficacy, and patient-reported outcomes of these procedures.