Survey of current management of prolapse in Australia and New Zealand

Objective: To compare current practice in the treatment of pelvic organ prolapse between Australian/New Zealand and United Kingdom (UK) gynaecologists. Methods: A postal questionnaire containing questions on four case scenarios, which examined contentious areas of contemporary prolapse management, was sent to 1471 Australian and New Zealand gynaecologists in mid-2007. The results were compared with those of an identical survey conducted in the UK in 2006. Results: The response rate was 13% as only 196 complete responses were received. For primary anterior vaginal prolapse, anterior colporrhaphy was the procedure of choice in 54% followed by vaginal repair with graft in 20%. For recurrence, 75% used a graft. Procedure of choice for uterovaginal prolapse was a vaginal hysterectomy with anterior colporrhaphy (79%) and for vault support, 54% performed uterosacral colpopexy. In women wishing to retain their fertility, 23% would operate and a laparoscopic uterosacral hysteropexy (39%) was preferred. For posterior vaginal prolapse, the procedure of choice was midline plication in 56% and site-specific repair in 24%. A graft was used in 13% for primary repair and 61% for recurrence, most preferring permanent mesh. Procedure of choice for apical prolapse was sacrospinous fixation with anterior and posterior colporrhaphy (37%), followed by vaginal mesh repair (33%) and abdominal sacrocolpopexy (11%). Few respondents objectively measured prolapse (20%) or followed up patients over one year (12%). Conclusions: Australian/New Zealand gynaecologists used fewer traditional transvaginal procedures and more vaginal grafts than their UK colleagues in all compartments. Most respondents favoured permanent mesh (eg mesh kits) and many are missing an opportunity to gather valuable prospective data on these new procedures.