This worldwide survey had the aim to evaluate the current approach on female stress urinary incontinence (SUI) surgery, on combined surgery in women with SUI and pelvic organ prolapse (POP), and on the use of prosthetic material.

This is an online worldwide survey on current trends in female SUI surgery, combined surgery for associated SUI and POP, use of mesh and tape in urogynaecology (April 2021-still ongoing). Social media (Twitter, Medical Group on Facebook, WhatsApp, Messenger), emails, were used to collect data by a link referring to a database. Demographic respondent’s data, use of pelvic floor muscle training in SUI patients, type of SUI surgery, performance of combined surgery for associated SUI and POP, and use of prosthetic materials were investigated. In some questions more than one answer was possible.

A total of 420 responders completed the survey. Urologists were 80.7% (339/420), and the remaining 19.3% were gynaecologists. Half of the respondents (49.8%). had completed a fellowship in female urology/urogynecology. Age and geographic location of responders is reported in table 1. Female urology/urogynaecology was practiced <10 years by the 64.3%. 
Pelvic floor muscle training was reported as the first treatment option for SUI by 74.9% (figure 2). In 80.6% of respondent’s mid urethral sling (MUS) was the preferred surgical treatment for uncomplicated SUI with urethral hypermobility (table 2). Autologous fascial sling (42.4%), bulking agents (31.9%), and abdominal colposuspension (212.6%) were the potential substitutes for MUS when MUS was not available. Combined surgery for associated SUI and POP is performed by 55.2%. Reasons to not perform associated surgery are reported in table 3. The routine use of transvaginal mesh for POP was reported by 44.8%, while 13.5% used it only for recurrent POP. After the April 2019 FDA ban on MESH only 29.5% of respondent stopped using MESH, while 37% still use it (table 4).

This survey was able to give a picture of the worldwide trend in SUI and POP surgery. MUS was still the preferred surgical procedure for uncomplicated SUI. When MUS is not available a more invasive treatment such as autologous fascial sling was preferred with respect to bulking agents due to the consolidated data on long term success rate. Considering that 64% of respondents would use an abdominal surgical approach (sling or Burch) the first goal for surgeons was to resolve SUI, rather than limiting surgical invasiveness and potential complications. Combined surgery for associated SUI and POP were performed by the majority of the responders (55.2%). This data confirmed that this topic is still debated. Approximately half of surgeons did not consider a combination surgery due to personal attitudes (“no confidence” or “not my standard approach”), while 52.1% decided on the basis of literature data. Surprisingly even after the FDA ban, the majority of respondents still use mesh for transvaginal POP repair.

This survey confirmed that MUS was the preferred SUI surgery and that female urologists/urogynecologists are still divided in the one step treatment of SUI associated to POP. The use of mesh was higher than expected particularly considering the mesh ban in several countries.