Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis : Urogynecology

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AUGS Research Report

Medium-Term Outcomes of Conservative and Surgical Treatments for Stress Urinary Incontinence: A Medicare Claims Analysis

Hall, Evelyn F. MD; Biller, Daniel H. MD, MHMC; Buss, Joanna L. MS; Ferzandi, Tanaz MD, MBA, MA§; Halder, Gabriela E. MD, MPH; Muffly, Tyler M. MD; Nickel, Katelin B. MPH∗∗; Nihira, Mikio MD, MPH††; Olsen, Margaret A. PhD, MPH∗∗; Wallace, Shannon L. MD‡‡; Lowder, Jerry L. MD, MSc§§

Author Information
Urogynecology 29(6):p 536-544, June 2023. | DOI: 10.1097/SPV.0000000000001362

Abstract

Objective 

This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older.

Methods 

This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment.

Results 

Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons).

Conclusions 

In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.

Erratum

When originally published, Volume 29, Issue 6 (June 2023) was incorrectly paginated. The issue pagination has been corrected. The publisher apologizes for the error.

Urogynecology. 29(9):784, September 2023.

© 2023 American Urogynecologic Society. All rights reserved.

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