Virginia Via Research Day Book 2026

Medical Student Research Clinical

37 SHIFTING PARADIGMS IN SURGICAL PRACTICES OF STRESS URINARY INCONTINENCE: NATIONAL TRENDS TOWARD MINIMALLY INVASIVE AND MESH-FREE APPROACHES

Yasaman Dasteh Goli, OMS-IV; James Mahaney, PhD; Gökhan Kilic, MD Corresponding author: ydastehgoli@vcom.edu

VCOM-Virginia, Blacksburg, Virginia University of Texas Medical Branch, League City, Texas

Burch colposuspension. Methods: A retrospective cross-sectional study was conducted using large national de-identified clinical encounters (US Collaborative Network). The analysis included women aged 45-80 years who underwent surgical treatment for SUI from 2015-2024. CPT-coded SUI procedures including MUS (CPT 57288), urethral bulking injections (identified only when CPT 51715 and L8606 were billed together), and other continence surgeries were extracted. Because our aim was to examine procedural trends, counts represent procedure claims rather than unique individuals. Annual procedure volumes and proportional utilization of each procedure type were calculated to characterize temporal trends across the study period. Results: MUS remained the predominant surgical intervention throughout the study period, consistent with its status as first-line intervention for SUI. Although MUS utilization remained high, its proportional share declined modestly from 92.18% of SUI procedures in 2015 to 78.32% in 2024; reflecting a gradual diversification of practice rather than a displacement of MUS. Urethral bulking procedures demonstrated substantial growth, increasing from 4.89% in 2015 to 19.72% in 2024, likely driven by patient preference

for minimally invasive, office-based, or repeatable therapies. Concurrently, advances in modern surgical techniques, particularly robotic assistance and the use of fluorescence guidance, allowed for improved visualization of the Retzius space to support a renewed clinical adoption of the modified Burch colposuspension as a mesh-free alternative with promising safety and efficacy outcomes. Conclusion: Despite the continued prominence of MUS procedures, national trends reveal a dynamic broadening of the surgical landscape. The growing use of urethral bulking and the renewed adaption of the modified Burch procedure reflect increasing interest in alternative, minimally invasice, and mesh-free interventions. Continued comparative research is needed to evaluate long-term outcomes across these modalities and to strengthen evidence-based guidance for patient centered surgical decision making.

Context: Stress urinary incontinence (SUI) is a highly prevalent pelvic floor disorder, and midurethral slings (MUS) remain the first-line surgical treatment due to their minimally invasive approach, excellent long-term outcomes, and consistently high patient satisfaction rates. However, evolving patient preferences, the desire for office-based procedures, or mesh-free options, and advancements in surgical visualization and robotics have widened the therapeutic landscape. Urethral bulking agents are increasingly favored for their minimally invasive nature, and there is renewed interest in mesh-free procedures such as modified Burch colposuspension as supported by enhanced retropubic access and modern robotic techniques. Despite MUS remaining the gold standard management of SUI, these emerging options are gaining momentum. This study was undertaken to better understand how national procedural patterns are shifting and to characterize the evolving nature of SUI surgical management in real-world practice. Objective: To perform a comprehensive analysis of national SUI surgical trends from 2015-2024 within a large multi-institutional dataset, assessing changes in MUS utilization and evaluating the increasing adaption of urethral bulking procedures and renewed interest in

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207 2026 Research Recognition Day