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Title: What a mesh! An Australian experience using national female continence surgery trends over 20 years
Austin Authors: McVey, Aoife ;Qu, Liang G ;Chan, Garson ;Perera, Marlon ;Brennan, Janelle;Chung, Eric;Gani, Johan 
Affiliation: Urology
Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
Department of Urology, Bendigo Health, Bendigo, VIC, Australia
Issue Date: Oct-2021
Date: 2021-04-09
Publication information: World journal of urology 2021-10; 39(10): 3931-3938
Abstract: To review the evolution of female continence surgical practice in Australia over the last 20 years and observe whether vaginal mesh controversies impacted these trends. From January 2000 to December 2019, medicare benefit schedule codes for female continence procedures were identified and extracted for: mesh sling, fascial sling, bulking agent, female urethral prosthesis, colposuspension, and removal of sling. Population-adjusted incidences per 100,000 persons were calculated using publicly available demographic data. Three discrete phases were defined over the study time frame for analysis: 2000-2006; 2006-2017, and 2017-2019. Interrupted time-series analyses were conducted to assess for impact on incidence at 2006 and 2017. There were 119,832 continence procedures performed in Australia from 2000 to 2019, with the mid-urethral sling (MUS) the most common (72%). The majority of mesh (n = 63,668, 73%) and fascial sling (n = 1864, 70%) procedures were in women aged < 65 years. Rates of mesh-related procedures steeply declined after 2017 (initial change: -21 cases per 100,000; subsequent rate change: -12 per 100,000, p < 0.001). Non-mesh related/bulking agents increased from + 0.34 during 2006-2017 to + 2.1 per 100,000 after 2017 (p < 0.001). No significant change in mesh extraction was observed over 2006-2017 (+ 0.06 per 100,000, p = 0.192). There was a significant increase in mesh extraction procedures after 2017 (0.83 per 100,000, p < 0.001). Worldwide, controversy surrounding vaginal mesh had a significant impact on Australian continence surgery trends. The most standout trends were observed after the 2017 Australian class-action lawsuit and Senate Inquiry.
DOI: 10.1007/s00345-021-03691-9
ORCID: 0000-0003-2709-2454
Journal: World Journal of Urology
PubMed URL: 33837448
Type: Journal Article
Subjects: Mid-urethral sling
Stress urinary incontinence
Surgical mesh
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