Management of anterior vaginal prolapse in South Africa – results of a national survey

Objective. A national survey of the management of anterior vaginal prolapse by gynaecologists and urologists in South Africa. Methods. 822 questionnaires were sent by post to all registered gynaecologists and urologists in South Africa. Results. 47 questionnaires were returned undelivered, and 234 (30.2%) were returned completed. The respondents comprised 180 gynaecologists (23.2%) and 54 urologists (7.0%). The POP-Q staging system was most commonly used (37.6%), but 36.3% did not use any recognised system. Urodynamic investigation was done pre-operatively by 8.6% of the gynaecologists and 20.8% of the urologists (p=0.0121, 95% confidence interval (CI) –24.0 - –0.7%). Anterior colporraphy was done by 85.5% of the respondents and vaginal paravaginal repair by 41.9%, and mesh was used by 55.1%. Urologists made use of mesh more often than gynaecologists (p=0.001, 95% CI –43.3 - –16.9%). Conclusion. The practice of anterior vaginal prolapse repair was fairly standard except for a few reports of preoperative urodynamics by gynaecologists and high use of synthetic mesh by urologists.