Since the Food Drug Administration ban on vaginal mesh for prolapse in 2019, concerns are emerging about the use of mesh  in Female Medicine Pelvic and Reconstructive Surgery. As the Internet has become a predominant source of healthcare information, we analyzed search trends related to stress urinary incontinence treatments worldwide using the "Google trends" tool.

We performed a retrospective analysis using Google Health Trends online tool. It is a web-based tool provides access to a representative random sample of all Google search queries. Data related to treatment options for SUI (‘pelvic floor muscles exercises’, ‘continence pessary’, ‘pubovaginal slings', 'Burch colposuspension', 'midurethral slings', ‘Injectable bulking agents’) were extracted from January 2004 to August 2022. Data for searched terms were expressed as relative search volume on a scale from 0 to 100. Comparisons of annual relative search volume, average annual percentage change, and temporal patterns were analyzed to assess loss or gain of interest. The join-point regression model was used to identify significant changes in mean annual relative search volume over time for each treatment. Finally, we evaluated the impact of the last FDA alert on Internet searching for SUI treatment options.

The mean annual relative search volume for “midurethral slings” was 20% in 2006 and decreased thereafter, reaching a nadir of 8% in 2022 (average annual percentage change : -4 %; p < 0.01). Pubovaginal slings interest was limited until 2020  (average annual percentage change: – 2.2%; p<0.01) and has since experienced renewed interest (average annual percentage change : +2.8%; p<0.01). A regular decrease interest was recorded for Burch colposuspension (average annual percentage change: – 1.2%; p<0.01). Conversely, a steep interest was found in injectable bulking agents (average annual percentage change: +4.4 %; p<0.01), continence pessary (average annual percentage change: +0.2 %; p<0.01).  and pelvic floor muscles exercises’ (average annual percentage change: + 0.5 %; p<0.01). When trends were compared before and after the 2019 FDA ban, the median annual relative search volume  of “Pubovaginal sling” and “Injectable bulking agents” increased from 5 (4-6) to 8 (6-16) (p<0.001) and from 13.5 (11-16) to 23 (19-27) (p<0.001), respectively. At the same time, a decrease was observed for “MUS”: 10 (7-16) vs. 7 (6.8.5); (p<0.001).

The number of online searches for mid-urethral slings has decreased with the various FDA warnings regarding transvaginal meshes. Conservative measures, bulkings agents, and pubovaginal slings seem to have seen a parallel resurgence in interest.

Understanding these trends allows us to anticipate changes in health care and meet the public's expectations