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Trends in prolapse surgery in England

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Abstract

Introduction and hypothesis

Women have a lifetime risk of undergoing pelvic organ prolapse (POP) surgery of 11–19%. Traditional native tissue repairs are associated with reoperation rates of approximately 11% after 20 years. Surgery with mesh augmentation was introduced to improve anatomic outcomes. However, the use of synthetic meshes in urogynaecological procedures has been scrutinised by the US Food and Drug Administration (FDA) and by the European Commission (SCENIHR). We aimed to review trends in pelvic organ prolapse (POP) surgery in England.

Methods

Data were collected from the national hospital episode statistics database. Procedure and interventions-4 character tables were used to quantify POP operations. Annual reports from 2005 to 2016 were considered.

Results

The total number of POP procedures increased from 2005, reaching a peak in 2014 (N = 29,228). With regard to vaginal prolapse, native tissue repairs represented more than 90% of the procedures, whereas surgical meshes were considered in a few selected cases. The number of sacrospinous ligament fixations (SSLFs) grew more than 3 times over the years, whereas sacrocolpopexy remained stable. To treat vault prolapse, transvaginal surgical meshes have been progressively abandoned. We also noted a steady increase in uterine-sparing, and obliterative procedures.

Conclusions

Following FDA and SCENIHR warnings, a positive trend for meshes has only been seen in uterine-sparing surgery. Native tissue repairs constitute the vast majority of POP operations. SSLFs have been increasingly performed to achieve apical support. Urogynaecologists’ training should take into account shifts in surgical practice.

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References

  1. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190(1):27–32.

    Article  Google Scholar 

  2. Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.

    Article  Google Scholar 

  3. Lowenstein E, Moller LA, Laigaard J, Gimbel H. Reoperation for pelvic organ prolapse: a Danish cohort study with 15–20 years' follow-up. Int Urogynecol J. 2018;29(1):119–24.

    Article  Google Scholar 

  4. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:CD004014.

    Google Scholar 

  5. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11:CD004014.

    PubMed  Google Scholar 

  6. Gutman RE. Does the uterus need to be removed to correct uterovaginal prolapse? Curr Opin Obstet Gynecol. 2016;28(5):435–40.

    Article  Google Scholar 

  7. Jha S, Cutner A, Moran P. The UK National Prolapse Survey: 10 years on. Int Urogynecol J. 2017;29(6):795–801.

    Article  Google Scholar 

  8. Burns EM, Rigby E, Mamidanna R, Bottle A, Aylin P, Ziprin P, et al. Systematic review of discharge coding accuracy. J Public Health (Oxf). 2012;34(1):138–48.

    Article  CAS  Google Scholar 

  9. Withington J, Hirji S, Sahai A. The changing face of urinary continence surgery in England: a perspective from the hospital episode statistics database. BJU Int. 2014;114(2):268–77.

    Article  Google Scholar 

  10. Gibson W, Wagg A. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of hospital episode statistics data. BJOG. 2016;123(8):1386–92.

    Article  CAS  Google Scholar 

  11. NHS Digital. Retrospective Review of Surgery for Urogynaecological Prolapse and Stress Urinary Incontinence using Tape or Mesh 2018 [Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mesh/apr08-mar17/retrospective-review-of-surgery-for-vaginal-prolapse-and-stress-urinary-incontinence-using-tape-or-mesh-copy#key-facts.

  12. Mascarenhas T, Mascarenhas-Saraiva M Jr, Ricon-Ferraz A, Nogueira P, Lopes F, Freitas A. Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J. 2015;26(1):113–22.

    Article  Google Scholar 

  13. Kurkijarvi K, Aaltonen R, Gissler M, Makinen J. Pelvic organ prolapse surgery in Finland from 1987 to 2009: a national register based study. Eur J Obstet Gynecol Reprod Biol. 2017;214:71–7.

    Article  Google Scholar 

  14. Skoczylas LC, Turner LC, Wang L, Winger DG, Shepherd JP. Changes in prolapse surgery trends relative to FDA notifications regarding vaginal mesh. Int Urogynecol J. 2014;25(4):471–7.

    Article  Google Scholar 

  15. Younger A, Rac G, Clemens JQ, Kobashi K, Khan A, Nitti V, et al. Pelvic organ prolapse surgery in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications. Urology. 2016;91:46–51.

    Article  Google Scholar 

  16. Notten KJ, Essers BA, Weemhoff M, Rutten AG, Donners JJ, van Gestel I, et al. Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment. BJOG. 2015;122(6):873–80.

    Article  CAS  Google Scholar 

  17. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717–24. discussion 24–8

    Article  CAS  Google Scholar 

  18. Paz-Levy D, Yohay D, Neymeyer J, Hizkiyahu R, Weintraub AY. Native tissue repair for central compartment prolapse: a narrative review. Int Urogynecol J. 2017;28(2):181–9.

    Article  Google Scholar 

  19. Mowat A, Wong V, Goh J, Krause H, Pelecanos A, Higgs P. A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation. Aust N Z J Obstet Gynaecol. 2018;58(1):119–24.

    Article  Google Scholar 

  20. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83.

    Article  Google Scholar 

  21. Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):470.e1–6.

    Article  Google Scholar 

  22. Detollenaere RJ, den Boon J, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717.

    Article  Google Scholar 

  23. Moen MD, Richter HE. Vaginal hysterectomy: past, present, and future. Int Urogynecol J. 2014;25(9):1161–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urogynaecology, Norfolk and Norwich University Hospital, Norwich, UK

    Martino Maria Zacche, Sambit Mukhopadhyay & Ilias Giarenis

Authors
  1. Martino Maria Zacche
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  2. Sambit Mukhopadhyay
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  3. Ilias Giarenis
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Correspondence to Martino Maria Zacche.

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Conflicts of interest

Martino Zacche does not have any conflict of interest. Sambit Mukhopadhyay accepted travel expenses from Dynamesh, Astellas, Kebomed UK, Cook Medical. Ilias Giarenis received speaker honoraria from Astellas.

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Zacche, M.M., Mukhopadhyay, S. & Giarenis, I. Trends in prolapse surgery in England. Int Urogynecol J 29, 1689–1695 (2018). https://doi.org/10.1007/s00192-018-3731-2

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  • DOI: https://doi.org/10.1007/s00192-018-3731-2

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