Surgical Management of Stress Urinary Incontinence: A Questionnaire Based Survey
Introduction
The prevalence of urinary incontinence has been identified in approximately 14% of women above 30 years of age [1]. With an increase in the postmenopausal female population there is a growing demand for improved management of pelvic-floor dysfunction. This has led to the establishment of urogynaecology as a separate subspecialty of gynaecology.
The management of urodynamic stress incontinence (USI) has seen considerable progress since the days when Poussan advocated advancement of the urethra in 1892 [2]. However there continues to be considerable disparity in the surgical management of USI.
The purpose of our study was to establish a consensus in the surgical management of USI amongst members of the International Urogynaecology Association (IUGA) worldwide.
Section snippets
Methods
The questionnaire was developed by asking urogynaecology practitioners what they felt were contentious issues in the surgical management of USI. This three-page questionnaire (Appendix A) was sent to the 530 members listed in the IUGA directory 2004. The addresses and email addresses were obtained from the directory. A covering letter describing the objectives of the study accompanied the questionnaire. After one month reminders were sent to the members via email. Those who had not completed
Results
A total of 217 questionnaires were received i.e. 41% response rate. Of these only 202 were used for analysis, as 15 were from physiotherapists who were not performing any surgery. This gave us a useable response rate of 38%. Though we asked respondents to give the single most appropriate answer this was not strictly adhered to. In several questionnaires more than one option was chosen. In these cases each response chosen was analysed.
Of the 202 responses obtained 60% were from teaching
Discussion
It is evident that there is considerable variation in surgical practice in the management of USI. In the absence of an evidence-based approach to most aspects of the surgical management, the technique and methods are guided predominantly by the surgeons’ personal preference.
Although the useable response rate was only 38%, there were sufficient replies to make this a valid consensus. The validity would have been greater however, if we had received a better response. The poor response may be
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