International Urogynecology Journal

, Volume 19, Issue 12, pp 1639–1646 | Cite as

The distribution of different surgical types for female stress urinary incontinence among patients’ age, surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

  • Ming-Ping Wu
  • Kuan-Hui Huang
  • Cheng-Yu Long
  • Kuo-Feng Huang
  • Ken-Jen Yu
  • Chao-Hsiun Tang
Original Article


This study aims to identify the changing trends of different surgical types for female stress urinary incontinence (SUI) and the distribution amongst various providers’ characteristics. A total of 17,532 women who had undergone surgery for SUI during 1996–2005 were identified from the National Health Insurance Research Database for analysis. Retropubic urethropexy (RPU) was the most common surgical type (43%), followed by tension-free mid-urethral sling (MUS; 24%), and traditional pubovaginal sling (15%). MUS had an annual growth rate of 20.5%, whilst traditional pubovaginal sling was reduced by 11.3% annually after 2002. RPU was the most common procedure by both gynecologists and urologists. Gynecologists performed more Kelly plications, whereas urologists performed more traditional pubovaginal sling. MUS was more commonly performed in medical centers than in regional and local hospitals. There has been a notable growth and changing trend in various surgical types for female SUI in Taiwan.


Mid-urethral sling (MUS) Retropubic urethropexy (RPU) Sling Stress urinary incontinence (SUI) Surgery Tension-free vaginal tape (TVT) National Health Insurance Taiwan 



The authors are grateful for the financial support provided by Chi Mei Foundation Hospital, Taiwan (94CM-KMU-03 and 96CM-KMU-05).

Conflicts of interest



  1. 1.
    Abram P, Andersson KE, Brubaker L, Cardozo L, Cottenden A, Denis L et al (2005) Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. 3rd International Consultation on Incontinence:1589–1630Google Scholar
  2. 2.
    Yu HJ, Wong WY, Chen J, Chie WC (2003) Quality of life impact and treatment seeking of Chinese women with urinary incontinence. Qual Life Res 12:327–333PubMedCrossRefGoogle Scholar
  3. 3.
    Chen GD, Lin TL, Hu SW, Chen YC, Lin LY (2003) Prevalence and correlation of urinary incontinence and overactive bladder in Taiwanese women. Neurourol Urodyn 22:109–117PubMedCrossRefGoogle Scholar
  4. 4.
    Rovner ES, Wein AJ (2004) Treatment options for stress urinary incontinence. Rev Urol 6(Suppl 3):S29–S47PubMedGoogle Scholar
  5. 5.
    Burch JC (1961) Urethrovaginal fixation to Cooper’s ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol 81:281–290PubMedGoogle Scholar
  6. 6.
    Schick E, Jolivet-Tremblay M, Tessier J, Dupont C, Bertrand PE (2004) Observations on the function of the female urethra: III: an overview with special reference to the relation between urethral hypermobility and urethral incompetence. Neurourol Urodyn 23:22–26PubMedCrossRefGoogle Scholar
  7. 7.
    Raz S, Stothers L, Young GP, Short J, Marks B, Chopra A et al (1996) Vaginal wall sling for anatomical incontinence and intrinsic sphincter dysfunction: efficacy and outcome analysis. J Urol 156:166–170PubMedCrossRefGoogle Scholar
  8. 8.
    Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29:75–82PubMedCrossRefGoogle Scholar
  9. 9.
    de Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730PubMedCrossRefGoogle Scholar
  10. 10.
    Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:81–85 discussion 85–86PubMedCrossRefGoogle Scholar
  11. 11.
    Wang AC, Lo TS (1998) Tension-free vaginal tape. a minimally invasive solution to stress urinary incontinence in women. J Reprod Med 43:429–434PubMedGoogle Scholar
  12. 12.
    Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U (2001) Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 12(Suppl 2):S5–S8PubMedCrossRefGoogle Scholar
  13. 13.
    Department of Health, Health and National Health Insurance Annual Statistics Information Services.
  14. 14.
    Lapitan MC, Cody DJ, Grant AM (2005) Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev:CD002912Google Scholar
  15. 15.
    Balmforth J, Cardozo LD (2003) Trends toward less invasive treatment of female stress urinary incontinence. Urology 62:52–60PubMedCrossRefGoogle Scholar
  16. 16.
    Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE et al (2007) Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med 356:2143–2155PubMedCrossRefGoogle Scholar
  17. 17.
    Minassian VA, Al-Badr A, Drutz HP, Lovatsis D (2004) Tension-free vaginal tape, Burch, and slings: are there predictors for early postoperative voiding dysfunction? Int Urogynecol J Pelvic Floor Dysfunct 15:183–187PubMedCrossRefGoogle Scholar
  18. 18.
    Bezerra CA, Bruschini H (2001) Suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev:CD001754Google Scholar
  19. 19.
    Nilsson CG, Falconer C, Rezapour M (2004) Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 104:1259–1262PubMedGoogle Scholar
  20. 20.
    Kondo A, Isobe Y, Kimura K, Kamihira O, Matsuura O, Gotoh M et al (2006) Efficacy, safety and hospital costs of tension-free vaginal tape and pubovaginal sling in the surgical treatment of stress incontinence. J Obstet Gynaecol Res 32:539–544PubMedCrossRefGoogle Scholar
  21. 21.
    Lim MY, Perera M, Ramsay I, Tierney J, Hardwick C (2007) Surgical management of stress urinary incontinence in Scotland and Wales: a questionnaire study. Int J Surg 5:162–166PubMedCrossRefGoogle Scholar
  22. 22.
    Davila GW, Ghoniem GM, Kapoor DS, Contreras-Ortiz O (2002) Pelvic floor dysfunction management practice patterns: a survey of members of the International Urogynecological Association. Int Urogynecol J Pelvic Floor Dysfunct 13:319–325PubMedCrossRefGoogle Scholar
  23. 23.
    Novara G, Ficarra V, Boscolo-Berto R, Secco S, Cavalleri S, Artibani W (2007) Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol 53:288–308PubMedCrossRefGoogle Scholar
  24. 24.
    Surgical treatment of urodynamic stress incontinence. Royal College of Obstetricians and Gynecologists Guideline No. 5:1–9Google Scholar
  25. 25.
    Hunskaar S, Lose G, Sykes D, Voss S (2004) The prevalence of urinary incontinence in women in four European countries. BJU Int 93:324–330PubMedCrossRefGoogle Scholar
  26. 26.
    Tseng IJ, Chen YT, Chen MT, Kou HY, Tseng SF (2000) Prevalence of urinary incontinence and intention to seek treatment in the elderly. J Formos Med Assoc 99:753–758PubMedGoogle Scholar
  27. 27.
    Diokno AC, Sand PK, Macdiarmid S, Shah R, Armstrong RB (2006) Perceptions and behaviours of women with bladder control problems. Fam Pract 23:568–577PubMedCrossRefGoogle Scholar
  28. 28.
    Griffiths JM, Black NA, Pope C, Stanley J, Bowling A, Abel PD (1998) What determines the choice of procedure in stress incontinence surgery? The use of multilevel modeling. Int J Technol Assess Health Care 14:431–445PubMedCrossRefGoogle Scholar
  29. 29.
    Tension-free vaginal tape (TVT) procedure. Int J Gynaecol Obstet 91:279–282Google Scholar

Copyright information

© The International Urogynecological Association 2008

Authors and Affiliations

  1. 1.Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and GynecologyChi Mei Foundation HospitalTainanTaiwan
  2. 2.Department of Obstetrics and Gynecology, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.Department of Obstetrics and GynecologyChang Gung Memorial HospitalKaohsiungTaiwan
  4. 4.Kaohsiung Municipal Hsiao-Kang HospitalKaohsiungTaiwan
  5. 5.Kaohsiung Veterans General HospitalKaohsiungTaiwan
  6. 6.School of Health Care Administration, College of MedicineTaipei Medical UniversityTaipeiTaiwan

Personalised recommendations