World journal of urology · 2026
Female stress urinary incontinence surgical trends in New Zealand from 2010 to 2025: before and after a mesh pause and national surgeon credentialing.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Fong Eva, Keane Michael, Lo Sum Sum, Losco Giovanni, Ecclestone Hazel
Аннотация
OBJECTIVES: To examine trends in surgical management of female stress urinary incontinence (SUI) from 2010 to 2025 including the impact of the mesh pause of August 2023 and national credentialing of surgeons.
METHODS: This retrospective cohort study used the Health New Zealand National Minimum Dataset (hospital events, NMDS). This includes all publicly funded hospital events from 2010-2025 for female stress urinary incontinence procedures being: mesh slings, fascial slings, Colposuspension and periurethral bulking agents.
RESULTS: There was significant and sustained decline in female SUI procedures beginning in 2013 to 2022. There was also a shift in procedural types with mesh slings being the predominant procedure before 2020 and periurethral bulking agents increasing from 2017. Following the mesh pause, there was no change in overall SUI activity prior to and after the pause. However, there was shift in the predominant procedures from mesh slings to periurethral bulking agents. In younger age groups the fall in sling procedures and increase in bulking was more marked. In the context of surgeon credentialing which began in 2022 through till october 2025, we found 64% of Colposuspensions and 22% of fascial slings were performed at a hospital without a New Zealand framework credentialled surgeon. Due to NMDS database being hospital/procedural based, we assigned credentialing at hospital level which may overestimate the availability of credentialled expertise at the hospital level.
CONCLUSION: Between 2010 to 2025, there has been a sustained decline in female SUI procedures in New Zealand public hospitals. This decline began in 2013, nine years before the mesh pause of 2023. There has been a significant shift in the predominant SUI procedures following the mesh pause from highly efficacious procedures, mesh slings, to periurethral bulking agents, which are less efficacious. We also found that following credentialing, a significant proportion of procedures were performed in hospitals without a credentialed surgeon.
METHODS: This retrospective cohort study used the Health New Zealand National Minimum Dataset (hospital events, NMDS). This includes all publicly funded hospital events from 2010-2025 for female stress urinary incontinence procedures being: mesh slings, fascial slings, Colposuspension and periurethral bulking agents.
RESULTS: There was significant and sustained decline in female SUI procedures beginning in 2013 to 2022. There was also a shift in procedural types with mesh slings being the predominant procedure before 2020 and periurethral bulking agents increasing from 2017. Following the mesh pause, there was no change in overall SUI activity prior to and after the pause. However, there was shift in the predominant procedures from mesh slings to periurethral bulking agents. In younger age groups the fall in sling procedures and increase in bulking was more marked. In the context of surgeon credentialing which began in 2022 through till october 2025, we found 64% of Colposuspensions and 22% of fascial slings were performed at a hospital without a New Zealand framework credentialled surgeon. Due to NMDS database being hospital/procedural based, we assigned credentialing at hospital level which may overestimate the availability of credentialled expertise at the hospital level.
CONCLUSION: Between 2010 to 2025, there has been a sustained decline in female SUI procedures in New Zealand public hospitals. This decline began in 2013, nine years before the mesh pause of 2023. There has been a significant shift in the predominant SUI procedures following the mesh pause from highly efficacious procedures, mesh slings, to periurethral bulking agents, which are less efficacious. We also found that following credentialing, a significant proportion of procedures were performed in hospitals without a credentialed surgeon.