Rising Rates of Urethral Bulking: A Retrospective Study of a National Database.

Importance: Stress urinary incontinence (SUI) affects approximately 50% of women. There are limited data regarding trends in management as treatment options have changed.

Objective: This study aimed to analyze trends in the surgical management of SUI, including slings and urethral bulking, from 2012 to 2022.

Study Design: Patients from the American College of Surgeons National Surgical Quality Improvement Program database who had undergone a sling or urethral bulking procedure were identified by Current Procedural Terminology code. Descriptive statistics and independent paired t tests were performed.

Results: A total of 81,657 patients received either slings or urethral bulking from 2012 to 2022. The number of slings performed peaked in 2017, decreased in 2020, and has subsequently increased. The rate of urethral bulking increased from 2019 to 2022. The average age patients who received urethral bulking was 64 years versus 56 years for sling patients (P < 0.05). These patients were more likely to be American Society of Anesthesiology class III compared to those receiving slings (39% vs 25%, respectively, P < 0.05). Readmission and reoperation rates were not statistically different. Less invasive procedures were more likely to be performed concurrently with bulking.

Conclusions: Sling placement is the most common surgical procedure for SUI but it decreased in 2020, likely due to COVID-19-related delays, and has not yet returned to prepandemic levels. Urethral bulking has become more common, possibly due to new agents available in U.S. markets. Patients who received urethral bulking were more likely to be older, have severe systemic disease, and underwent a less invasive concurrent procedure. Further research is needed to understand these trends.