Survey on Canadian Experience in Pelvic Organ Prolapse Repair and the Use of Transvaginal Mesh Systems

Abstract

Abstract

Objective: The purpose of this article is to describe the practice of gynecologists and urogynecologists in pelvic organ prolapse repair, and their experience with transvaginal mesh systems. Design: The study was designed as an electronic survey. Materials and Methods: An electronic survey was distributed to members of the Society of Obstetricians and Gynaecologists of Canada. Questions pertained to preferred surgical procedures treating pelvic organ prolapse and experience with transvaginal mesh systems. Results: Twenty-eight percent of respondents who perform surgeries for pelvic organ prolapse have used transvaginal mesh systems, including 56.5% of surveyed urogynecologists. Seventy-eight percent of respondents using transvaginal mesh systems reported a mesh exposure rate of 0%–5% in their practice. The most common reason for not using transvaginal mesh systems was the lack of available long-term evidence about their success and complication rates (42.6%). Knowledge of the United States Food and Drug Administration (FDA) notification concerning complications associated with transvaginal mesh systems influenced the practice of 42.9% of respondents. The preferred procedure for primary and recurrent repair of pelvic organ prolapse was traditional colporrhaphy (92.4% and 42.4% in the anterior compartment; 80.9% and 51.5% posteriorly, respectively). Transvaginal mesh systems were used for recurrent cystoceles by 20.0% of surveyed general gynecologists and 22.7% of urogynecologists (p=0.307). Fifteen percent of all respondents used them for recurrent rectoceles. Conclusions: Transvaginal mesh systems were most commonly used for recurrent anterior compartment prolapse by only 20% of respondents. Close to one third of surveyed gynecologists are waiting for stronger evidence prior to using them. There is an ongoing need for rigorous long-term studies regarding the benefits and risks of these procedures. (J GYNECOL SURG 30:129)