National survey on the management of prolapse in the UK

• Published in: Neurourology and urodynamics Vol. 26; no. 3; pp. 325 - 331
• Main Authors: Jha, Swati, Moran, Paul A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.01.2007
• Subjects: anterior vaginal wall prolapse; apical vaginal prolapse; cystocele; enterocele; Female; Gynecology - statistics & numerical data; Health Care Surveys - methods; Humans; Hysterectomy, Vaginal - statistics & numerical data; Hysterectomy, Vaginal - utilization; pelvic organ prolapse; posterior vaginal wall prolapse; Professional Practice - statistics & numerical data; rectocele; Surveys and Questionnaires; United Kingdom; Uterine Prolapse - surgery; vault prolapse
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.20331

Aims To assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners, and compare practice between urogynaecologists (tertiary centres), gynaecologists with a special interest in urogynaecology and general gynaecologists. Methods 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. Results Four hundred fifty‐eight responses were received and 398 were completed. For anterior vaginal wall prolapse, anterior colporrhaphy was the procedure of choice in 77% of respondents. With concomitant urodynamic stress incontinence, a Burch was the procedure of choice in 11%, but 79% of respondents would perform a midurethral tape combined with repair. In women with utero‐vaginal prolapse the procedure of choice was a vaginal hysterectomy and repair (82%). Twenty‐four percent of respondents would operate in women whose family was incomplete. In women with posterior vaginal wall prolapse (PWP), the procedure of choice was posterior colporrhaphy with midline fascial plication (75%). For vault prolapse, 66% of respondents would operate. Thirty‐six percent would perform urodynamics prior to surgery. The procedure of choice was an abdominal sacrocolpopexy (38%). Conclusion There are wide variations in the surgical management of prolapse. Management of POP by urogynaecologists varied in some respects from the general gynaecologists, but were similar to the practices of gynaecologists with a designated interest in urogynaecology. Neurourol. Urodynam. 26:325–331, 2007. © 2007 Wiley‐Liss, Inc.