Page 3 - CUA2018 Abstracts - Miscellaneous/Other

Podium session 3: Miscellaneous

Research, University of Toronto, Toronto, ON, Canada cantly increased (95 to 147 per 100 000 population; p<0.001) driven by a
Study Groups: University of Toronto Functional Urology Research. significant increase in TVS procedures (19 to 129 per 100 000 population;
Introduction: Since 1999, transvaginal sling (TVS) procedures have been p<0.001). During this time period, the number of urethropexy, abdomi-
an effective treatment for Canadian women with stress urinary inconti- nal/vaginal sling, and bulking agent procedures significantly decreased
nence (SUI). However, complications associated with transvaginal mesh (p<0.001). After 2009, annual rates of any SUI procedure decreased, a
led to warnings from the U.S. Food and Drug Administration (FDA) and trend which continued during the remainder of the study period (147 to
Health Canada in 2008 and 2010, respectively. We hypothesized that 64 per 100 000 population; p<0.001). This trend was associated with a
these warnings would significantly decrease the use of TVS procedures significant decrease in TVS procedures (130 to 60 per 100 000 popula-
for SUI. Therefore, we sought to characterize trends in the surgical man- tion; p<0.001) over the same period, as well as significant declines in
agement of SUI in a single–payer healthcare system in Ontario, Canada each of the other SUI treatment modalities (p<0.001).
over a 22–year period. Conclusions: This large, population–based cohort demonstrates a signifi-
Methods: We performed an interrupted time–series analysis using seg- cant influence of the FDA and Health Canada warnings on patient and
mented regression among women aged 18 years and older undergoing physician behaviour regarding the management of SUI. Prior to 2009,
surgical treatment for SUI between January 1, 1994 and December 31, despite decreased use of other surgical procedures, the overall number of
2016 in Ontario, Canada. The passage of time was considered the primary SUI surgeries performed was significantly increasing, driven by increasing
exposure. The outcome was the annual population–adjusted rates of SUI use of TVS procedures. Following the regulatory warnings, the overall rate
surgery over time stratified by modality: urethropexy, TVS, abdominal/ of SUI procedures significantly declined due to a decrease in the use of
vaginal sling, and transurethral bulking agents. both TVS procedures and other operative interventions. These data suggest
Results: We identified 120 999 women who underwent SUI surgery that the regulatory warnings had a significant effect on how patients and
between 1994 and 2016. The total number of SUI procedures did not physicians approach surgical management of SUI. Further, it suggests that
significantly change from 1994–2000 (mean 95 per 100 000 population; many women may be living with untreated SUI.
p=0.89). From 2000–2009, the total number of SUI procedures signifi-

CUAJ • June 2018 • Volume 12(6Suppl2) S59