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Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007

Rogo- u!ta ", "itwin M#, #aigal $#, %nger &T' (rologic )iseases in %merica Pro*ect+ )a,id (#%+ effen #chool of Medicine, (ni,ersity of $alifornia, "os %ngeles, $%,

Oleh Bambang Purwono

1%( guidelines consider sling. %$O . Marshall-Marchetti-6rant70 was the most commonly !erformed !rocedure But in 2003 the sling and the suburethral bul2ing !rocedures was most commonly • • • . sling !rocedures is dominant for management of #(-n 3442. la!arosco!ic sus!ensions and in*ectable bul2ing agents as acce!table treatment o!tions+ The !ast decade.-.ati. urethro!e5y /Burch.e management should be considered for all acce!table surgical o!tions+ %(%. • • uidelines recommend that women with stress urinary incontinence /#(-0 who fail conser.TRO)($T-O.

Objective • To describe trends in the surgical management of female stress urinary incontinence /#(-0 in the (nited #tates from 2002 to 2007 .

was identified (sing $urrent Procedural Terminology /$PT-.• %naly7ed data from a 89 national random sam!le of female Medicare beneficiaries aged :8 and older+ • )ata were obtained from the $enters for Medicare and Medicaid #er.0 !rocedure codes were included in the analysis+ • Trends were analy7ed o.ices carrier and out!atient files from 2002 to 2007+ • #ub*ect diagnosed with urinary incontinence identified by the /-$)-40 diagnosis codes • Treatment for #(.er the :-year !eriod+ Methode .

Results .

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<.4.• The total of 243.=.4.. which increased from 28.0 !rocedures in 2002 to ==.=20 in 2007+ • Procedures !erformed in ambulatory surgery centers and !hysician offices increased.<<0 !rocedures in 2007+ • -n*ectable bul2ing agents  second most common !rocedure.300 !rocedures in 2002 but decreased to 33.3<0 !rosedure for #(. which accounted for 3. although those !erformed in in!atient settings declined+ >os!ital out!atient !rocedures remained stable .400 in 2007+ • #lings  the most common !rocedure across all years.were identified during the study !eriod • the total number of surgical !rocedures stable during the study !eriod.0 in 2002 to . from .

aginal ta!e /T@T' gynecare.&0  uncom!licated suggest 77-4=9 of !atient remain cured 30 years after sling !alcement • % decline in surgical !rocedures !erformed in the hos!ital in!atient setting has been demontrated for #(? !el.ile. somer.? good long-term durability • "ong term data on retro!ubic tension-free-.)-#$(##-O. . • #ling ha.e become the most widely !erformed surgical !rocedure for #(.ic organ !rola!s .

both of which are easily !erformed in out!atient settings+ .shifted toward a dominance of !rocedures !erformed in ambulatory surgery centers from 2002 to 2007 • #lings remained the dominant surgical !rocedure.$onclusions • The surgical management of women with #(. followed by in*ectable bul2ing agents.

Terima 2asih .