Female pelvic medicine and reconstructive surgery practice patterns: IUGA member survey
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Introduction and hypothesis
The purpose of this study is to describe the current practice patterns of the International Urogynecological Association (IUGA) members regarding the diagnosis, evaluation, and surgical management of stress urinary incontinence (SUI) and pelvic organ prolapse (POP).
A 30-item internet-based survey was sent to IUGA members. Response to the survey was voluntary, and subjects answered questions regarding demographics, the evaluation of POP and SUI, including urodynamics (UDS) testing, preferred management of POP and SUI, and the application of mesh in reconstructive surgery.
Three hundred and thirty-four IUGA members responded to the survey; most of the responses were from Europe (40 %) and North America (23 %). After the FDA safety communication regarding serious complications of using transvaginal mesh, 45 % of responders reported decreased use of mesh, while 31 % reported that it had no effect or that they did not use mesh for transvaginal prolapse (23.6 %). Regarding the evaluation and treatment of SUI, 51 % of responders would perform urodynamics (UDS) before surgical correction of uncomplicated SUI and 78.5 % of responders would perform UDS if no urine leakage was demonstrated on examination. The preferred method of treatment for SUI is midurethral sling (MUS), regardless of prior treatments (65.1 %), concomitant surgeries (74.5 %), or examination findings (50.8–92.6 %). Regarding POP repair, the preferred approach for apical (61 %) and posterior (99.4 %) prolapse repair is vaginal.
Most respondents use a vaginal approach for POP surgery. The FDA safety communication regarding serious complications related to the use of transvaginal mesh for prolapse surgery led to a global decrease in the employment of mesh for POP. Synthetic midurethral slings are predominant in the current treatment of SUI. Despite new recommendations, many responders still perform UDS for uncomplicated SUI.
KeywordsIUGA Practice patterns Survey Pelvic organ prolapse Stress urinary incontinence
US Food and Drug Administration
International Urogynecological Association
Pelvic organ prolapse
Stress urinary incontinence
IUGA members of the Research and Development committee for their input into the questionnaire development; the IUGA office, Washington DC, for their help with emails, letters, blinding, and prize donation. The survey questionnaire can be accessed through the IUGA website: http://www.iuga.org/members/group_content_view.asp?group=142683&id=440098. The link to the PDF is: http://c.ymcdn.com/sites/www.iuga.org/resource/collection/50CEC9BC-67F5-4620-8DFF-8117251AE88D/IUGA_Practice_Patterns_Survey_2014.pdf.
Financial disclaimers/conflict of interest statement
Gamal Ghoniem: uroplasty; research grant ROSE Registry (HS: 2011–8420); Jessica Hammett: none.
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