Trends in prolapse surgery in England

Area of Science:

• Urogynecology
• Surgical Trends
• Pelvic Organ Prolapse

Background:

• Pelvic organ prolapse (POP) affects a significant number of women, with traditional repairs having notable reoperation rates.
• The use of synthetic mesh in POP surgery has faced scrutiny from regulatory bodies like the FDA and SCENIHR.
• Native tissue repairs were the standard, but mesh augmentation was introduced to improve outcomes.

Purpose of the Study:

• To review and analyze trends in pelvic organ prolapse (POP) surgery in England between 2005 and 2016.
• To understand the impact of regulatory warnings on surgical practices for POP.
• To identify shifts in surgical techniques for treating different types of prolapse.

Main Methods:

• Utilized data from the national hospital episode statistics database in England.
• Quantified POP operations using Procedure and Interventions-4 character tables.
• Analyzed annual reports from 2005 to 2016 to identify surgical trends.

Main Results:

• Total POP procedures peaked in 2014, with native tissue repairs comprising over 90% of vaginal prolapse surgeries.
• Sacrospinous ligament fixations (SSLFs) increased over threefold, while sacrocolpopexy remained stable.
• Transvaginal mesh use for vault prolapse decreased, with a rise in uterine-sparing and obliterative procedures.

Conclusions:

• Following regulatory warnings, mesh use in POP surgery has decreased, except in uterine-sparing procedures.
• Native tissue repairs are the predominant surgical approach for POP.
• Increased use of SSLFs for apical support highlights a shift in surgical practice, necessitating updated urogynaecologist training.