2141 CHANGES IN PELVIC ORGAN PROLAPSE SURGERY OVER THE LAST DECADE AMONG US UROLOGISTS

Abstract

INTRODUCTION AND OBJECTIVES: Surgical correction of pelvic organ prolapse (POP) has undergone a transformation over the past decade with the introduction of trans-vaginally placed mesh kits and the proliferation of laparoscopic/robotic surgery. Training in POP surgery, ease of mesh kit use and FDA warnings on mesh use have all influenced practice patterns. We investigated trends in the use of these treatments over the last decade among US urologists. METHODS: Data on POP procedures (colporrhaphy, colpopexy, hysterectomy), mesh usage (placement, revision), and pessary use were obtained from the American Board of Urology (ABU) via annualized case log data from certifying and recertifying urologists between 2003-2012. Associations between surgeon characteristics (type of certification, annual volume, practice type and location) and use of POP procedures were evaluated. RESULTS: Among 6,355 urologists applying for certification or recertification between 2003 and 2012, 2,192 reported performing any procedures for POP. POP procedures have risen steadily over the past decade, from 930 procedures in 2003 to 6,978 procedures in 2012. Colporrhaphies have increased each year, from 806 to 2670 between 2003-2012. Colpopexies increased steadily from 2003 (n 32) through 2012 (n 1414). Vaginal colpopexies increased from 24 to 1016 between 2003-2012. Sacrocolpopexies rose from 8 cases in 2003 to 398 cases by 2012. Laparoscopic sacrocolpopexies increased exponentially, reaching 282 cases by 2012. Mesh insertion rose sharply from 10 in 2005 to 640 in 2006, and to 1552 in 2012 (p 0.0005). There were no mesh revisions reported between 2003-2006. In 2007, 52 revisions were performed and the number of revisions has increased consistently up to 2012 (n 214). Nearly 40% of surgeons who perform POP surgery used mesh, whereas 6% reported performing mesh revisions. The rate of hysterectomies was low over time, with only 34 surgeons reporting use for POP. Pessary use has remained stable over time. Urologists who completed a female urology fellowship performed more POP procedures (p 0.0005). CONCLUSIONS: POP surgical procedures performed by US urologists have increased significantly over the last decade. The rise in colporrhaphies has been mirrored by the rise in mesh utilization. More colpopexies are now performed presumably due to an increased understanding of the need for apical repair. Sacrocolpopexy has increased exponentially perhaps due to adoption of robotic techniques amongst urologists. The proliferation of mesh-based surgeries has given rise to a latter trend of mesh revision surgeries for complications.