Recent developments in technology for the assessment and management of incontinence.

Urinary incontinence, the leakage of urine, is a common condition, which can have a significant impact on a patient's quality-of-life. Incontinence may arise as a consequence of a weakness of the urinary sphincter or bladder dysfunction, usually over-activity. Incontinence therapies occupy a large proportion of the healthcare budget. As no single device to manage incontinence is appropriate for all situations, a diverse range of products are available on the market and the development of improved products based on fundamental designs has been slow. This review highlights some of the key issues of continence care and describes the current technology and recent developments involved in the diagnosis, assessment and treatment of incontinence, along with the strengths and limitations of these methods. These issues are imperative to address if improved technology is to be developed.

Mesh sling in an era of uncertainty: lessons learned and the way forward.

Following transvaginal mesh, synthetic slings to correct stress urinary incontinence have been put under further scrutiny. Since the recent FDA website update, we reviewed the latest developments and then reflected on the lessons learned by applying this process and the way forward.

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

OBJECTIVE: To describe trends in the surgical management of female stress urinary incontinence (SUI) in the United States from 2002 to 2007. METHODS: As part of the Urologic Diseases of America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries aged 65 and older. Data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 2002 to 2007. Women who were diagnosed with urinary incontinence identified by the International Classification of Diseases, Ninth Edition (ICD-9) diagnosis codes and who underwent surgical management identified by Current Procedural Terminology, Fourth Edition (CPT-4) procedure codes were included in the analysis. Trends were analyzed over the 6-year period. Unweighted procedure counts were multiplied by 20 to estimate the rate among all female Medicare beneficiaries. RESULTS: The total number of surgical procedures remained stable during the study period, from 49,340 in 2002 to 49,900 in 2007. Slings were the most common procedure across all years, which increased from 25,840 procedures in 2002 to 33,880 procedures in 2007. Injectable bulking agents were the second most common procedure, which accounted for 14,100 procedures in 2002 but decreased to 11,320 in 2007. Procedures performed in ambulatory surgery centers and physician offices increased, although those performed in inpatient settings declined. Hospital outpatient procedures remained stable. CONCLUSION: The surgical management of women with SUI shifted toward a dominance of procedures performed in ambulatory surgery centers from 2002 to 2007, although the overall number of procedures remained stable. Slings remained the dominant surgical procedure, followed by injectable bulking agents, both of which are easily performed in outpatient settings.