Factors influencing physicians' recommendations for surgical treatment and mode of delivery in reproductive-age women with stress urinary incontinence: Insights from an international survey.

OBJECTIVE

To determine physicians' attitudes towards surgical treatment for stress urinary incontinence (SUI) and its consequences for women of childbearing age.

METHODS

Electronic survey approved by the International Urogynecological Association (IUGA) and American Urogynecologic Society (AUGS), distributed to their members.

RESULTS

A total of 191 physicians completed the survey. The majority of respondents (115, 60.2%) stated that they would perform or recommend surgical treatment for SUI for patients who have not yet completed their family planning, although most (136, 71.2%) would advise them to postpone surgery until completion of their family planning. Male physicians tended to recommend surgery more readily than their female counterparts, while female physicians were more likely to advise postponing surgery until completion of childbearing (58 respondents [76.3%] vs. 56 [53.3%] P = 0.002; 87 [79.8%] vs. 47 [62.7%], P = 0.01, respectively). Physicians with subspecialty training were more likely to endorse surgical treatment as compared to physicians without such training (94 respondents [68.6%] vs. 21 [44.7%], P = 0.003). Physicians from North America were more likely to recommend surgical treatment for SUI as compared to their colleagues from other countries (82 respondents [71.3%] vs. 33 [47.8%], P < 0.001). If surgery would be considered, 98 respondents (51.3%) would use bulking agents as their procedure of choice followed by retropubic mid-urethral sling (MUS) (78 respondents [40.8%]). Following continence surgery, 64 respondents (37.4%) would recommend postponing subsequent pregnancy for 6-12 months and 50 respondents (26.2%) would recommend a permanent contraception procedure. Following anti-incontinence surgery, 91 respondents (47.6%) would recommend an elective cesarean section; however, in cases of persistent SUI, 144 respondents (75.4%) would recommend a trial of labor (TOL). Experienced (>5 years) physicians were less likely to recommend a TOL following continence surgical intervention as compared to less experienced (<5 years) physicians (67 respondents [45.9%] vs. 33 [73.3%], P < 0.001).

CONCLUSION

The current study results indicate that most physicians would recommend postponing surgical intervention until completion of family planning. In cases where surgery was recommended, bulking agents were the procedure of choice. Our survey demonstrated significant variability in physicians' attitudes towards the mode of delivery in women following anti-incontinence surgeries, affected by their gender, experience, geographical area of practice and patient continence status.