TRENDS IN PELVIC ORGAN PROLAPSEMANAGEMENT IN LATIN AMERICA
M. PLATA1, D. ROBLEDO1, A. BRAVO-BALADO 1, J. C. CASTAÑO 2,M. AVERBECK 3, M. PLATA 4, J. G. CATAÑO 5,J. I. CAICEDO 1, C. G. TRUJILLO 1;
1Dept.of Urology, Hosp. Univ.rio Fundación Santa Fe de Bogotá and Univ.de los Andes Sch. of Med., Bogotá, Colombia, 2Dept. ofUrology, Clínica Univ.ria CES, Univ. CES and Pontificia Univ.Bolivariana, Medellín, Colombia, 3Dept. of Urology, Mãede Deus Ctr. Hosp., Porto Alegre, Brazil, 4Dept. ofGynecology, Obstetrics and Human Reproduction, Hosp. Univ.rioFundación Santa Fe de Bogotá and Univ. de los Andes Sch. of Med.,Bogotá, Colombia, 5Dept. of Urology, Hosp. Univ.rioFundación Santa Fe de Bogotá, Bogotá, Colombia.
Introduction: Pelvic organprolapse (POP) is a prevalent condition that compromises quality oflife on a physical, mental and emotional scale.(1) Variation existsregarding its management, extending from a conservative approach tosurgical procedures.(2) A widespread increase in mesh-based repairssince the last decade prompted a substantial change in practicepatterns.(3) However, reports on complications led to the issuing ofwarnings and notifications from regulatory agencies worldwide,(4)followed by the introduction of new technologies and a renewedinterest in traditional procedures. The impact of such events inLatin America (LATAM) has not been assessed.
Objective: Todescribe practice patterns and perspectives regarding POP managementamong urologists, gynecologists and urogynecologists in LATAM in2016.
Methods: A cross-sectional study was conducted fromApril to September 2016 using a 37-item internet-based survey,applied to members of urologic and gynecologic associations from 18countries. To comply with inclusion criteria, participants had tohave valid credentials and be members of these associations in theircountry of residence. Participants were asked about their background,education and practice patterns, as well as opinions and perceptionsregarding POP management. Descriptive statistics wereemployed.
Results: A total of 673 responses were obtained.Most responses came from Colombia (n = 226, 33.6%) and Brazil (n =166, 24.7%). The sample included 440 (65.4%) urologists, 183 (27.2%)gynecologists and 50 (7.4%) urogynecologists. There were differencesamong specialties regarding POP management training: 171 (93.4%)gynecologists reported having POP training during residency versus242 (55.0%) urologists and 38 (76.0%) urogynecologists. Additionally,only 56 (35.9%) gynecologists reported using mesh-based repairs forPOP versus 36 (72.0%) urogynecologists and 210 (65.0%) urologists.From those participants who perform at least one POP procedure permonth, 315 (59.5%) use the POP-Q classification for assessment.Regarding prolapse surgery for apical POP, vaginal approach waspreferred over abdominal (56.6% vs 26.4%). Mesh-based POP repairswere used by 302 (57.1%) of participants. Out of non-mesh users, themost frequent vaginal procedures were sacrospinous fixation (n = 167,39.8%), anterior or posterior colporrhaphy (n = 202, 32.9%), anduterosacral fixation (n = 78, 15.4). Non-formal training inmesh-based POP repairs provided by manufactures and colleagues wasreported by 141 (45.2%) and 134 (42.9%) participants, respectively.Regarding the impact of FDA warnings, 397 (75.2%) indicated that theuse of mesh has declined, and 208 (41.9%) considered this has had anegative effect on the use of incontinence tapes as well. Respondentsperceived a median reduction of 50% (range 0-100%, IQR = 10-80) inmesh use in their own practice. Only 2 (0.4%) participants reportedlegal disputes related to mesh procedures and 400 (75.8%) said theywould still indicate mesh repairs in certain cases. Out of the totalrespondents, 420 (79.5%) do not use the ICS-IUGA complication reportform and 342 (64.5%) were not familiar with it.
Conclusions:This is the first report on POP practice patterns in LATAM.Preferences regarding surgical management of POP are not verydifferent from international trends. Despite intense scrutiny andmedia exposure, mesh-based procedures are still largely used inLATAM. Legal matters do not represent a big concern. Non-formaltraining is still an issue to be addressed. Certain educationalfactors among the population, access to medical services, trainingand rational use of these procedures may have influenced thesefindings.
References: 1. Am J Obstet Gynecol.2006;194(5):1455-1461. doi:10.1016/j.ajog.2006.01.060.2. ObstetGynaecol Reprod Med. 2012;22(5):118-122.doi:10.1016/j.ogrm.2012.02.003.3. Obstet Gynaecol Reprod Med.2012;22(5):118-122. doi:10.1016/j.ogrm.2012.02.003.
4. IntUrogynecol J Pelvic Floor Dysfunct. 2013;24(5):707-718.doi:10.1007/s00192-012-20253.
Table1. Participants' characteristics
Universityhospital and private practice
Table2. Participants' practice patterns
Urodynamictesting for symptomatic POP > stage III
Evaluationfor occult stress urinary incontinence (OSUI)
OSUItreatment + POP repair