October 2020

Authors: Evelyn Hall, MD, Daniel Biller, MD, Mikio Nihira, MD, MPH, Eric Hurtado, MD, Galen Conti, MPH, Margaret Olsen PhD, MPH, Joanna Reale, MS, Katelin Nickel, MPH, Jerry Lowder, MD, MS

Video Presentation: Evelyn Hall, MD

The AUGS Payment Reform Committee compared treatment failure of conservative and surgical treatment modalities for stress urinary incontinence. This retrospective cohort study used a Medicare dataset that utilized inpatient, outpatient, and carrier claims. Survival analysis was used to evaluate time from treatment initiation to retreatment with a different treatment modality. In this cohort, 13,510 women were included with an index treatment between 2008 and 2013 and follow-up continuing through 2016, with a mean age of 76.6 years. In this cohort, 26.0% received physical therapy, 41.6% received pessary and 32.3% underwent sling surgery as a first line therapy for their SUI. There was no difference between all three treatment groups. If retreatment with the same initial treatment was considered a failure, surgical approaches had a statistically lower rate of retreatment than pessary and physical therapy. At 5 years, approximately 90% of surviving patients who underwent these treatment modalities had not undergone further retreatment.

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