title: Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh.
abstract: OBJECTIVE
  Pelvic organ prolapse (POP) surgery has lately gained importance in gynecological practice. This study aims to characterize the evolution of POP surgical procedures conducted in Portugal in the last decade and the impact of an FDA 2011 safety communication on mesh POP surgeries.
  
  
  METHODS
  Trends in the surgical management of POP were assessed using the Portuguese National Medical Registry. We considered all records of women with diagnosis of genital prolapse from 1 January 2000 to 31 December 2012. Additionally, we also conducted a survey among members of the Portuguese Society of Urogynecology to evaluate current practices in the surgical management of POP.
  
  
  RESULTS
  From 2000 to 2012, 46,819 diagnoses of genital prolapse were registered, with a 105 % increase during the study period (2,368 in 2000 to 4,941 in 2012). POP mesh surgery represented only 6 % of total prolapse diagnoses, but mesh use greatly increased up to 2011, when only a slight increase was registered. Among gynecologists who responded to the questionnaire, there was considerable variability on the procedures of choice to treat POP. Fifty-seven per cent of respondents performed vaginal mesh POP surgery, but only 27 % of those actually reported having changed their practice after the FDA 2011 safety communication.
  
  
  CONCLUSIONS
  Surgical procedures for POP conducted in Portugal greatly increased over the last decade. The use of surgical meshes is still limited, but despite FDA safety communication it has increased over the years, with a slight increase in 2012, which illustrates the need for further analyses in the coming years.
authors.affiliation: Department of Gynecology and Obstetrics, Hospital S. João, Faculty of Medicine of Porto University, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal, tqc@sapo.pt.
authors.forename: Teresa
authors.initials: T
authors.lastname: Mascarenhas
authors.forename: Miguel
authors.initials: M
authors.lastname: Mascarenhas-Saraiva
authors.forename: Amélia
authors.initials: A
authors.lastname: Ricon-Ferraz
authors.forename: Paula
authors.initials: P
authors.lastname: Nogueira
authors.forename: Fernando
authors.initials: F
authors.lastname: Lopes
authors.forename: Alberto
authors.initials: A
authors.lastname: Freitas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000706:statistics & numerical data*; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011174:Portugal; D012189:Retrospective Studies; D013526:Surgical Mesh; D014481:United States; D014486:United States Food and Drug Administration