# Analysis of functional urological surgery trends 2013–2024 in England using the HES database

## TL;DR

This study analyzed trends in urological surgeries in England from 2013 to 2024, showing shifts in treatment approaches due to safety concerns and the impact of the pandemic.

## Contribution

The study provides updated insights into the changing landscape of functional urological surgeries in England over an 11-year period.

## Key findings

- Transobturator and tension-free vaginal tape insertion for SUI was largely replaced by bulking agents after 2019 due to safety concerns.
- TURP remains the most common surgery for BPE, though laser resection methods are increasing in use.
- Surgical numbers dropped during the pandemic but partially recovered by 2022.

## Abstract

To review recent trends in common functional urology surgery in England, using the Hospital Episode Statistics (HES) database.

Data between 2013 and 2024 were obtained from the HES database, a publicly available dataset recording details about procedures in NHS England. We recorded the procedures for treatment of female stress urinary incontinence (SUI), urgency urinary incontinence (UUI), post-prostatectomy incontinence (PPI), vesicovaginal fistula (VVF) and benign prostatic enlargement (BPE) surgery.

Early in the study period, the most common procedures for SUI were insertion of transobturator and tension-free vaginal tape (8319 procedures/year). We observe an almost complete halt in tape insertion and an increase in removal from 2019 (8 procedures/year), due to concerns about complications and the ‘mesh pause’ in the UK. Injection of bulking agents became the mainstream treatment from 2019 (2490 procedures/year). For refractory UUI, intravesical Botulinum toxin A (BTX) remains the preferred treatment modality (9842 procedures/year). No significant increases in neuromodulation were observed (762/year), and numbers remain low for ileocystoplasty (100/year). Transurethral Resection of the Prostate (TURP) remains the commonest operation for BPE with 15,579 cases in 2023–2024. Laser resection modalities (Holmium laser Enucleation, or HoLEP, and Photoselective Vaporization of the Prostate, or PVP) saw increases with 5098 cases in 2023–2024. VVF repair numbers remain low, averaging 83 per year. There was a reduction in overall surgical numbers during the COVID-19 pandemic, with a partial recovery from 2022 onwards.

Due to concerns around tape-related complications, bulking agents are now the mainstream treatment of SUI in women, and BTX in UUI. Whilst the use of laser is becoming increasingly popular, TURP remains the commonest procedure performed for BPE. There has only been a partial recovery in surgical numbers following the pandemic.