title: Practice pattern variation in surgical management of pelvic organ prolapse and urinary incontinence in The Netherlands.
abstract: BACKGROUND
  Practice pattern variation (PPV) is the difference in care that cannot be explained by the underlying medical condition. The aim of this study was to describe PPV among Dutch gynecologists regarding treatment of pelvic organ prolapse (POP) and urinary incontinence (UI).
  
  
  METHODS
  PPV was calculated from data of healthcare declaration codes of 2010. Data were provided by Vektis and Kiwa Carity. PPV for POP and UI in general was calculated per hospital and per region. Furthermore, PPV for transvaginal mesh and surgical treatment of uterine descent was assessed.
  
  
  RESULTS
  PPV of surgical treatment for POP and UI in general was assessed for 91 hospitals. PPV for surgical treatment of uterine descent and transvaginal mesh placement was calculated for 88 hospitals. A high PPV per hospital and per region was found. In some hospitals, a hysterectomy was performed in all cases of uterovaginal prolapse, while in other hospitals, uterus-preserving techniques were mostly performed. A high PPV of transvaginal mesh placement was observed.
  
  
  CONCLUSIONS
  In the small country of The Netherlands, we found a high PPV in surgical management of POP and UI with respect to the choice for surgical treatment and the type of surgery. This finding might be due to the absence of clearly defined guidelines. Studies with respect to conservative versus surgical treatment and the type of surgery are of need to establish evidence-based guidelines.
authors.affiliation: Department of Obstetrics and Gynecology, PO Box 10500, 8000 GK, Zwolle, The Netherlands. m.n.van.ijsselmuiden@isala.nl.
authors.forename: Mèlanie N
authors.initials: MN
authors.lastname: van IJsselmuiden
authors.affiliation: Department of Obstetrics and Gynecology, PO Box 10500, 8000 GK, Zwolle, The Netherlands.
authors.forename: Renée J
authors.initials: RJ
authors.lastname: Detollenaere
authors.affiliation: Department of Obstetrics and Gynecology, PO Box 10500, 8000 GK, Zwolle, The Netherlands.
authors.forename: Maaike Y
authors.initials: MY
authors.lastname: Kampen
authors.affiliation: Department of Obstetrics and Gynecology, PO Box 10500, 8000 GK, Zwolle, The Netherlands.
authors.forename: Marian K
authors.initials: MK
authors.lastname: Engberts
authors.affiliation: Department of Obstetrics and Gynecology, PO Box 10500, 8000 GK, Zwolle, The Netherlands.
authors.forename: Hugo W F
authors.initials: HW
authors.lastname: van Eijndhoven
mesh_terms: D005260:Female; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D053825:Suburethral Slings / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000601:surgery*
keywords: Pelvic organ prolapse; Practice pattern variation; Treatment; Urinary incontinence