Urinary incontinence in women: study of surgical practice in France.

OBJECTIVE To assess the number and the types of surgical intervention for urinary incontinence among women in France. We are assuming that techniques by suburethral sling (SUS) have replaced Burch colposuspension. MATERIAL Using French hospital discharge data from the 2009 medical information system program (PMSI), we analyzed with regard to three relatively homogeneous diagnosis-related groups of patients (DRG) comprising the majority of stress urinary incontinence surgical interventions (cervicocystopexy, repair of the female genital apparatus, and hysterectomy) the detailed distribution of the different operations indexed in that information system. RESULTS More than 42,000 cervicocystopexies (42,223) were carried out in France in 2009, and a SUS was used in 92% of the procedures (n=38,929). In 58% of the cases (n=24,387) this surgery was the only one, and in the others, it was associated with static pelvic intervention in 25% of the cases (n=10,741) or with a hysterectomy in 16% (n=6671). When a cervicocystopexy was the only operation performed, the average age of the women was 56.5 years and the average stay in hospital was 12.9 days. Fifty-seven percent of the cervicocystopexies by SUS (n=24,037) were carried out in private sector. Mean durations of stay were significantly shorter in the private sector than in the public sector for the diagnosis-related groups undergoing cervicocystopexy or repair of the female genital apparatus. CONCLUSION In 2009, 10 years after its introduction in France, the suburethral sling is used in the overwhelming majority of cervicocystopexies in France. Among an estimated 4,000,000 incontinent women in France in 2009, this surgery was undergone by approximately 1% of them each year.