Google Searches for Stress Urinary Incontinence Treatment Options: A Worldwide Trend Analysis in the Synthetic Mesh Controversy Era

There are over 4 billion internet users worldwide and Google is the most used search engine. Nearly 70% of patients report that the Internet is their primary source of health information. Therefore, a new science has emerged from the age of Big Data, infodemiology, which can be defined as the study of the distribution and determinants of information in electronic platforms, particularly the Internet. To date, limited research has been conducted to examine how public online interest in SUI treatment has changed over time, especially in this context of controversy regarding synthetic meshes.

This study analyzed trends in online public interest search related to SUI treatment options, and specifically review the impact of the latest 2019 FDA ban related to vaginal mesh for prolapse repair on the use of midurethral slings and other corrective SUI procedures.

We used the web-based tool Google Trends to analyse online searches related to the following terms: ‘pelvic floor muscle exercises’, ‘continence pessary’, ‘pubovaginal slings’, ‘Burch colposuspension’, ‘midurethral slings’, ‘injectable bulking agents’. Data were expressed as relative search volume on a scale of 0–100, mean annual relative search volume (ARSV), and annual percentage change (APC).

The ARSV for midurethral slings decreased in 2022 (p < 0.01). Conversely, an increased interest was noted for injectable bulking agents and conservative therapies (p <0.01). A steady decline of interest was recorded for autologous surgeries but a regain of interest for pubovaginal slings was registered since 2020 (+2.8%; p<0.01). Comparing trends before and after the FDA 2019 alert, we observed a lower research volume for midurethral slings, and a higher research volume was observed for all other treatments (all p<0.05).

Some limitations in our study have to be pointed out. First, we are not able to identify the individuals performing the searches: the internaut can be the patient himself, its family or health workers. Consequently, it is not possible to draw any causal relationships from our data. However, the quantity of data analysed bolsters the study from an epidemiological perspective. Second, worldwide research was limited because not all countries have the same access to the internet, and English speakers were inevitably over-represented. Third, given Google’s algorithm for normalizing the search volume frequency, the exact search volume for the various searches is unavailable. Finally, Google is a dominant Internet search tool, but not the only available. The present study was limited to Google users and may not represent individuals who use one of the many other commercially available search engines to obtain health information.

Written by: Sonia Guérin,^1,2 Zine-Eddine Khene,^1,3 Benoit Peyronnet,³ Karim Bensalah,³ & Philippe E Zimmern⁴

Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA.
Department of Obstetrics, Gynecology and Human Reproduction, Rennes University Hospital, 16 Boulevard de Bulgarie, Rennes, France.
Department of Urology, Rennes University Hospital, 2 Rue Henri Le Guilloux, France.
Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA.

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