Analysis of functional urological surgery trends 2013-2024 in England using the HES database

Area of Science:

• Urology
• Surgical Trends
• Public Health Data Analysis

Background:

• Functional urology addresses conditions like incontinence and benign prostatic enlargement.
• Surgical interventions are key treatments for these conditions.
• Understanding recent trends is crucial for healthcare planning and patient care.

Purpose of the Study:

• To analyze recent trends in common functional urology surgeries in England.
• To identify shifts in treatment modalities and procedural volumes.
• To assess the impact of factors like mesh complications and the COVID-19 pandemic on surgical practices.

Main Methods:

• Utilized the Hospital Episode Statistics (HES) database for England.
• Analyzed procedure data from 2013 to 2024.
• Focused on treatments for female stress urinary incontinence (SUI), urgency urinary incontinence (UUI), post-prostatectomy incontinence (PPI), vesicovaginal fistula (VVF), and benign prostatic enlargement (BPE).

Main Results:

• Transobturator and tension-free vaginal tape use for SUI has sharply declined since 2019, replaced by bulking agents.
• Intravesical Botulinum toxin A (BTX) remains the primary treatment for refractory UUI.
• Transurethral Resection of the Prostate (TURP) is still the most frequent BPE surgery, though Holmium laser Enucleation (HoLEP) and Photoselective Vaporization (PVP) are increasing.
• Vesicovaginal fistula repair numbers remain low.
• Overall surgical volumes decreased during the COVID-19 pandemic, with partial recovery observed from 2022.

Conclusions:

• Bulking agents are now the standard for SUI treatment in women due to mesh complication concerns.
• BTX is the preferred modality for UUI.
• While laser prostate surgery gains popularity, TURP remains dominant for BPE.
• Surgical procedure numbers are still recovering post-pandemic.