The UK national prolapse survey: 5 years on

Swati Jha,Paul Moran

doi:10.1007/s00192-011-1379-2

Abstract

The objective of this study was to assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and the changes in management since this survey was first conducted 5 years ago. A postal questionnaire survey was sent to practising consultant gynaecologists in UK hospitals. They included urogynaecologists in tertiary centres, gynaecologists with a designated special interest in urogynaecology, and general gynaecologists. The questionnaire included case scenarios encompassing contentious issues in the surgical management of POP and was a revised version of the questionnaire sent 5 years ago. Two hundred and eighteen responses were received of which 190 were completed. For anterior vaginal wall prolapse, anterior colporrhaphy was still the procedure of choice in 71% of respondents. There was a significant rise in graft usage, particularly synthetic graft for recurrent prolapse (56%). A Burch was being performed by only 1% compared to 11% 5 years ago. In women with uterovaginal prolapse, the procedure of choice was still a vaginal hysterectomy and repair (82%). Thirty-five percent of respondents would operate in women whose family was incomplete. In women with posterior vaginal wall prolapse, the procedure of choice was posterior colporrhaphy with midline fascial plication in 66%, marginally less than the previous (75%). For vault prolapse, 73% of respondents would operate, and 43% would perform urodynamics prior to surgery. The procedure of choice was an abdominal sacrocolpopexy (44%), slightly greater than 5 years ago when it was 38%. Basic trends in prolapse surgery remain unchanged. The increase in the use of grafts is in patients with recurrent prolapse.

Highlights

Introduction and hypothesisTo assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and changes in practice since a previous similar survey
There has been a significant decrease in the use of vaginal mesh for both primary and recurrent prolapse, with increasing use of laparoscopic procedures for prolapse
Following US Food and Drug Administration (FDA) approval for vaginal mesh for POP in 2002, there was a significant increase in mesh procedures for both primary and recurrent prolapse, and recurrence rates were quoted as the reason for this increase

Summary

Introduction

To assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and changes in practice since a previous similar survey. The first UK prolapse survey was conducted in 2006. It highlighted widespread variations in practice in the surgical management of prolapse [1]. A second survey was conducted 5 years later [2] and demonstrated a consistent rise in the use of vaginal mesh with little change in the use of other surgical procedures for pelvic organ prolapse (POP). The risk of recurrent prolapse and the need for further surgery were responsible for the increase in mesh usage [3,4,5]. Recent studies suggest that the risk of recurrent prolapse in the same compartment after native tissue repair has been overestimated and is more likely to be in the region of 10% [6,7,8,9]

Methods

Results

Conclusion