Differences in Surgical Practice Patterns of Vaginal Native Tissue Repair for Pelvic Organ Prolapse Between Urologists and Gynecologists.

Abstract

Surgeon specialty training may influence the combination of transvaginal procedures for pelvic organ prolapse (POP) repair. Isolated transvaginal anterior compartment repair (AR) without concurrent apical suspension (ApS) is a known risk factor for POP recurrence. Our primary aim was to compare the prevalence of isolated AR between urologists versus gynecologists. Our secondary aim was to compare associated postoperative complications. We queried the American College of Surgeons National Surgical Quality Improvement Program for vaginal POP repair procedures (Current Procedural Terminology codes 57240, 57260, 57265, 57268, 57282, 57283) over a 5-year period by designated surgical specialty. We analyzed the relationships between specialty, vaginal repair type, operative details, and 30-day postoperative complications. Between January 2015 and December 2019, we included 16,093 women who underwent transvaginal POP repair, 90% performed by gynecologists and 10% by urologists. Urologists were more likely to perform an isolated AR without concurrent ApS (56% vs 47%, P < 0.0001). Gynecologists performed more isolated ApS (11% vs 9%) and combined AR with ApS (43% vs 35%, P < 0.0001). Overall, concurrent urethral sling placement was performed in 27% of cases, regardless of POP repair type, with no difference between specialties (P > 0.05). There were no differences in 30-day reoperations, readmissions, surgical site infections, urinary tract infections, or hospital stay lengths between specialties (P > 0.05). Urologists perform a minority of vaginal POP repairs and were more likely to perform isolated AR than gynecologists. The absence of concurrent ApS may increase the likelihood of prolapse recurrence. Immediate complication rates for each procedure did not differ.