The effect of advisory documents on mid-urethral sling case acquisition to the British Society Urogynaecology (BSUG) database in England


Introduction and hypothesis

Many advisory documents have recommended uploading of all mid-urethral sling (MUS) cases onto the British Society of Urogynaecology (BSUG) or British Association of Urological Surgeons (BAUS) database. The aim of this study was to determine whether these documents have resulted in an increase in database case acquisition for MUS surgery.


We determined the number of cases uploaded onto the BSUG and BAUS databases and cases acquired by Hospital Episode Statistics (HES) over the period January 2011–March 2017 for the 6 months prior to each document and 6 months afterwards.


There was an upsurge in data acquisition in 2013, which then declined after year end. There was a significant upsurge in case acquisition associated with the following documents: NHS Medical Director letter (p < 0.00001), the Healthcare Quality Improvement Partnership (HQIP) audit (p < 0.00001). There was a significant drop in case acquisition following the end of the HQIP audit (p < 0.00001) and the Mesh Working Group Interim report (p = 0.00325).


There was a significant increase in case acquisition with the HQIP audit and decline after it. The significant increase in case acquisition seen after the NHS MD letter in November 2012 may have been due to an overlap in the data capture between it and the HQIP audit. The levels of case acquisition do not compare to registries that are essentially compulsory and therefore we believe that voluntary databases are not effective for device post-market surveillance.

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Fig. 1


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We thank the British Society of Urological Surgeons for allowing us to use some of their data. This project was performed on behalf of the BSUG Database Committee and Database Users.

Author information




Ballard P: project lead, manuscript writing.

Teo R: data analysis, manuscript writing.

Khunda A: data analysis, manuscript writing.

Kershaw V: manuscript editing, data analysis.

Corresponding author

Correspondence to Paul Ballard.

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Conflict of interest

P Ballard: Educational grant from Olympus and Medronic (2019).

R Teo: none.

A Khunda: Educational grant from Olympus and Medtronic (since 2016).

V Kershaw: Educational Grant from Olympus.

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Ballard, P., Teo, R., Khunda, A. et al. The effect of advisory documents on mid-urethral sling case acquisition to the British Society Urogynaecology (BSUG) database in England. Int Urogynecol J 32, 135–140 (2021).

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  • Mid-urethral sling surgery
  • Database acquisition