A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair.
OBJECTIVE
Evidence-based medicine should result in better standardisation of practice. This study aims to evaluate whether there remains variation in surgical techniques in native tissue and graft/mesh repairs of pelvic organ prolapse (POP) in UK practice.


METHODS
A questionnaire survey was conducted to describe current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).


RESULTS
The questionnaire return rate was 90% (n = 56 out of 62). Substantial variations in surgical techniques were seen at every step of the procedure. Native tissue repair: most surgeons used infiltration, 95% (n = 53 out of 56), but the volume used varied (10-80 ml). All but one surgeon performed a midline incision; this surgeon performed an elliptical incision. The depth of tissue dissection varied, being both above and below the vaginal muscularis (fascia). Fascial repair methods included midline, closure of separate fascial defects, paravaginal repair and rectal/levator plication. Graft/mesh repairs: many different products and manufacturers were used. There was variation in the method of attachment of graft/mesh inserts and their placement in relation to the fascia. For both native tissue and graft/mesh repairs, the method of fascial dissection, suturing methods and suture material varied. Most surgeons inserted a pack, 91% (n = 50 out of 55), soaked in varying substances before use.


CONCLUSIONS
There is considerable variation between UK-based surgeons in the surgical techniques used to perform both native tissue and graft/mesh-augmented POP repairs. Further research is required to determine whether these differences influence outcome.
The Warrell Unit, Saint Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospital NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.|Division of Development Biology and Medicine, School of Medical Science, Faculty of Biology Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9WL, UK.
Emily
E
Fairclough
The Warrell Unit, Saint Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospital NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.|Division of Development Biology and Medicine, School of Medical Science, Faculty of Biology Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9WL, UK.
Jenny
J
Myers
The Warrell Unit, Saint Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospital NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.|Division of Development Biology and Medicine, School of Medical Science, Faculty of Biology Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9WL, UK.
Anthony Ross Broadhurst
ARB
Smith
Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Suzanne
S
Breeman
The Warrell Unit, Saint Mary's Hospital, Manchester Academic Health Science Centre, Central Manchester University Hospital NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK. Fiona.Reid@cmft.nhs.uk.|Division of Development Biology and Medicine, School of Medical Science, Faculty of Biology Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9WL, UK. Fiona.Reid@cmft.nhs.uk.
Fiona
F
Reid
D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D064792:Pragmatic Clinical Trials as Topic; D011446:Prospective Studies; D066231:Surgeons / Q000592:standards / Q000706:statistics & numerical data*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D006113:United Kingdom; D014621:Vagina / Q000601:surgery
Graft; Mesh; Native tissue; Pelvic organ prolapse; Surgical technique