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Purpose: To review the evolution of female continence surgical practice in Australia over the last 20 years and observe whether vaginal mesh controversies impacted these trends. Materials and methods: From January 2000 to December 2019, medicare benefit schedule codes for female continence procedures were identified and extracted for: mesh sling, fascial sling, bulking agent, female urethral prosthesis, colposuspension, and removal of sling. Population-adjusted incidences per 100,000 persons were calculated using publicly available demographic data. Three discrete phases were defined over the study time frame for analysis: 2000–2006; 2006–2017, and 2017–2019. Interrupted time-series analyses were conducted to assess for impact on incidence at 2006 and 2017. Results: There were 119,832 continence procedures performed in Australia from 2000 to 2019, with the mid-urethral sling (MUS) the most common (72%). The majority of mesh (n = 63,668, 73%) and fascial sling (n = 1864, 70%) procedures were in women aged < 65 years. Rates of mesh-related procedures steeply declined after 2017 (initial change: −21 cases per 100,000; subsequent rate change: −12 per 100,000, p < 0.001). Non-mesh related/bulking agents increased from + 0.34 during 2006–2017 to + 2.1 per 100,000 after 2017 (p < 0.001). No significant change in mesh extraction was observed over 2006–2017 (+ 0.06 per 100,000, p = 0.192). There was a significant increase in mesh extraction procedures after 2017 (0.83 per 100,000, p < 0.001). Conclusion: Worldwide, controversy surrounding vaginal mesh had a significant impact on Australian continence surgery trends. The most standout trends were observed after the 2017 Australian class-action lawsuit and Senate Inquiry. [ABSTRACT FROM AUTHOR]

Purpose: Sacral neuromodulation (SNM) is one of the few management options shown to improve outcomes in patients with detrusor underactivity (DU). This original research will investigate if preserved bladder contractility can predict a successful treatment with SNM. Methods: This is a retrospective study of a prospectively collected database of consecutive patients with DU, who had a staged SNM trial from January 2013 to December 2018, with a minimum of 12 months follow-up. The primary outcome was the success of stage 1 SNM trial. Results: In total, 69 patients with DU were followed. The median age was 67 [interquartile range (IQR) 74–55], median baseline bladder contractility index (BCI) 18 (IQR 67–0), and median post-void residual 200 mL (IQR 300–130). There were 35 patients (51%) that responded to a SNM trial. At a median follow-up of 23 months (IQR 39–12), three were removed for poor efficacy. In patients with detrusor acontractility (DAC), six responded (33%), compared to 29 patients (57%) with BCI > 0. This was statistically significant, p value 0.03. Younger age was also a predictive factor for SNM response, p value 0.02. There were no differences noted in those with gender, neurogenic history, previous pelvic surgery, diabetes, or pre-operative voiding history. Conclusion: Our study showed that patients with preserved bladder contractility are more likely to respond to a trial of SNM compared with those that have DAC. Younger age was also predictive of SNM response. UDS is the only method to accurately identify DAC patients. This information will help in patient selection and pre-operative counselling. [ABSTRACT FROM AUTHOR]

Purpose: Given the current and increasing awareness of the opioid crisis, this study aimed to characterise the types of analgesic prescription for conservatively managed renal colic. Methods: This was a retrospective cohort study of consecutive patients presenting to the Emergency Department (ED) in 2014–2019. Patients were included if they had radiographically confirmed obstructing calculus, managed conservatively without intervention, and were given a prescription for analgesia on discharge. Patient demographics were recorded and analysed. Opioid, non-opioid, and alpha-blocker medications were compared according to patient and disease parameters, and clinician training. Oral morphine equivalents (OMEs) were used to compare prescribed quantities. Subgroup analyses of stone size and location were performed. Results: Our analysis included 1761 patients with confirmed renal colic: median age of 50 years (16–96). Altogether, 88% of included patients were prescribed opioids on discharge, while only 68% were prescribed non-opioids (p < 0.001). Oxycodone immediate release was the most frequently prescribed analgesic. Logistic regression modelling controlling for patient and disease characteristics significantly predicted more non-opioid (p < 0.001) and alpha-blocker (p = 0.037) prescription with clinician training < 3 years. Linear regression modelling demonstrated that clinicians training < 3 years predicted lower OMEs per prescription compared to clinicians with ≥ 3 years of training (p = 0.001). Subgroup analyses supported similar predictions with training. Conclusions: Prescribing patterns are associated with different clinician experience levels. However, a substantial amount of opioids are still given overall on patient discharge regardless of the clinician experience. Educational interventions aimed at reducing the opioid prescription rate and quantities may be considered for clinicians of all training levels. [ABSTRACT FROM AUTHOR]