Practices in Pelvic Organ Prolapse Operations Among Surgeons: an International Survey Identifying Needs for Further Research

Objective And Hypothesis: Our aim was to identify variation in surgical technique for treating pelvic floor disorders looking specifically at differences in approach between subspeciality trained urogynaecologists and general gynaecologists. We hypothesised that speciality trained surgeons would have a more uniform operative technique. We did not make a hypothesis about which operative areas would have the most variation overall.

Methods: We performed a single-timepoint online survey of members of the International Urogynaecological Association (IUGA). Probability of difference from mean is presented as a raw value and significance of difference of means between surgical cohorts was calculated using the t test for independent variables.

Results: We received 205 responses from 118 general gynaecologists and 87 from subspecialty trained urogynaecologists (8 % response rate) to 27 questions concerning operative steps in four common urogynaecological operations. Surgeons had low levels of variation. The probability of any surgeon providing a different answer from the mode of their cohort was not significant within or between surgeons with and without subspeciality training (p = 0.47). Two areas with high levels of variation between surgeons were identified (probability of variation >0.5). These were: "In order to reduce cystocele, do you plicate the fascia covering the bladder or use vaginal tissue?" and "Would you usually plicate the rectovaginal facial septum to the vault?"

Conclusions: Most urogynaecological surgeries were of similar technique; however there were two areas of significant variation between surgeons that may affect outcomes and warrant further study.