Surgical decision-making for primary stress urinary incontinence: insights from a nationwide survey of gynecologists in Turkey.

OBJECTIVE

To delineate the surgical preferences of gynecologists in the management of primary stress urinary incontinence (SUI) and to explore the extent to which clinical experience, ingrained surgical habits, and procedural volume shape these therapeutic decisions.

METHODS

A national, web-based cross-sectional survey was distributed among practicing gynecologists across Turkey during the 2021 calendar year. Responses from 103 clinicians were analyzed. The questionnaire captured demographic profiles, operative case volumes, frequency of diagnostic laparoscopy, intraoperative cystoscopy practices, and the preferred surgical approach for primary SUI. Respondents were stratified into two cohorts: those favoring a vaginal sling procedure (encompassing TVT, TOT, or mini-sling techniques) and those opting for laparoscopic suspension (L/S), specifically laparoscopic colposuspension. Statistical computations were performed using IBM SPSS version 20.

RESULTS

A clear majority of respondents (87.1%) gravitated toward vaginal sling techniques, while laparoscopic suspension was the preferred approach for 12.9%. Notably, surgeons favoring the L/S route demonstrated a significantly higher annual volume of open Burch colposuspension experience (p = 0.041). The propensity for L/S was markedly diminished among clinicians who routinely perform intraoperative cystoscopy (p = 0.023). The overall distribution of annual diagnostic laparoscopy volume categories differed between the two surgical groups (p = 0.039), with the 5-20 cases category tending to be more frequent among surgeons who favored laparoscopic suspension. While no post-hoc pairwise comparisons were performed and the finding should be regarded as descriptive, it does suggest that a moderate, sustained engagement with laparoscopic surgery. No statistically significant intergroup variations were observed regarding age, years in practice, institutional setting, or geographic region.

CONCLUSION

The choice of surgical intervention for primary stress urinary incontinence extends beyond strict adherence to clinical guidelines; it remains intimately tied to the surgeon's individual technical repertoire and prior operative exposure. A background in advanced laparoscopy and the imprint of early surgical training emerge as potent determinants in the selection between retropubic suspension and sling-based therapies.