PD50-11 PROLAPSE REPAIR WITH AND WITHOUT APICAL RESUSPENSION - PRACTICE PATTERNS AMONGST CERTIFYING AMERICAN UROLOGISTS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 2015PD50-11 PROLAPSE REPAIR WITH AND WITHOUT APICAL RESUSPENSION - PRACTICE PATTERNS AMONGST CERTIFYING AMERICAN UROLOGISTS Joceline S. Liu, Matthias D. Hofer, Stephanie J. Kielb, and Sarah C. Flury Joceline S. LiuJoceline S. Liu More articles by this author , Matthias D. HoferMatthias D. Hofer More articles by this author , Stephanie J. KielbStephanie J. Kielb More articles by this author , and Sarah C. FlurySarah C. Flury More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anterior compartment prolapse is often associated with apical prolapse, with high rates of recurrence when anterior repair is performed without apical resuspension. We examined surgeon characteristics in certifying urologists performing prolapse surgeries. METHODS Six month case log data of certifying urologists between 2003 and 2013 was obtained from the American Board of Urology (ABU). Cases with a CPT code for uterosacral ligament suspension (USLS), sacrospinous ligament suspension (SSLS), abdominal sacrocolpopexy (ASC), and anterior or posterior colporrhpahy in females ≥18 years were analyzed for surgeon-specific variables. RESULTS Among 2588 urologists (526 female subspecialty) logging at least one prolapse surgery performing a total of 30,983 surgeries, 320 (1.0% of all cases) USLS, 3673 (11.9%) SSLS and 2618 (8.4%) ASC repairs were identified. Rates of laparoscopic ASC (62.8% overall) were similar by academic affiliation and specialty, although an increase is noted over time (31.4% before 2011, 79.0% ≥2011) (p<0.001). The remaining procedures included anterior colporrhaphy (8766 cases, 28.3% of all cases) and anterior/posterior repairs (5819, 18.8%), as well as posterior and paravaginal repairs. Prolapse case volume has increased from 534 in 2003 to 6271 in 2012 (p<0.001). Repairs including the anterior compartment far outnumbered apical repairs. Overall, 50.8% of anterior repairs did not include apical suspension. The proportion of anterior repairs without apical suspension has decreased from 77.7% in 2004 to 41.4% in 2012 (p<0.001). Female subspecialists before 2011 performed anterior repair without apical suspension in 55.6%, as compared to 68.0% by all others. Since 2011, there has been a decrease in number of anterior repairs without apical suspension, notably in those applying for Female Pelvic Medicine and Reconstructive Surgery (FPMRS) certification (7.5% vs. 24.0% by all other urologists, p<0.001). Non-academically-affiliated urologists are 2.6 times more likely to report anterior colporrhaphy without apical suspension than academically-affiliated colleagues; newly certifying urologists were more likely to perform prolapse repairs including apical suspension than those recertifying (p <0.001). CONCLUSIONS The proportion of prolapse repairs reported as anterior repairs without apical suspension is decreasing, although it remains a substantial portion. Academic affiliation, FPMRS, recent residency graduation and recent log year were associated with prolapse repairs addressing apical support. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1049 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joceline S. Liu More articles by this author Matthias D. Hofer More articles by this author Stephanie J. Kielb More articles by this author Sarah C. Flury More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...