title: Apical vaginal prolapse surgery:  practice patterns and factors guiding route of repair.
abstract: OBJECTIVE
  Describe current trends for repair of primary and recurrent apical vaginal prolapse using 4 different approaches, namely, transvaginal native (TVN) tissue, transvaginal using graft, laparotomy, or laparoscopic/robotic, and to determine which factors influence decision for favored approach.
  
  
  METHODS
  A 15-item survey was distributed to attendees of the 2011 Society of Gynecologic Surgeons meeting. Demographic data and percentages of routes of repair were collected. Twenty factors were graded on the importance for influencing surgical approach.
  
  
  RESULTS
  Transvaginal native tissue was the preferred route for primary repair (mean, 53.0%), and laparoscopic/robotic for recurrent repair (33.8%). Surgeons in academic practices, without formal postresidency training, and with lower surgical volumes were more likely to elect TVN for primary repair than alternatives. Important factors in selection of surgical approach included patient age and severity of medical comorbidities.
  
  
  CONCLUSIONS
  Among the Society of Gynecologic Surgeons meeting attendees, TVN is the preferred primary route for apical prolapse repair. Laparoscopic-assisted repairs are more common for recurrent prolapse.
authors.affiliation: University of Texas, Southwestern Medical Center, Dallas, TX, USA.
authors.forename: T Ignacio
authors.initials: TI
authors.lastname: Montoya
authors.forename: Kathryn B
authors.initials: KB
authors.lastname: Grande
authors.forename: David D
authors.initials: DD
authors.lastname: Rahn
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D014596:Uterine Prolapse / Q000601:surgery*; D055815:Young Adult