Impact and implications of changing practice in pelvic floor procedures: results from a registry survey

Abstract

Introduction The Australasian Pelvic Floor Procedure Registry (APFPR) was established in 2019 to monitor safety and efficacy of pelvic floor procedures (PFP) that use prostheses. This followed increased international and Australian regulation of mesh for PFPs, resulting in an overall reduction in PFPs and changes to the procedure profile. The aim of this study was to determine contributing factors and clinician responses to clinical practice trends, and implications for the APFPR.
Methods An online clinician survey was developed and distributed between July and October 2022 to APFPR contributing clinicians and USANZ and UGSA members. Descriptive statistics were calculated and stratified analysis performed.
Results Seventy-nine valid responses were received. Approximately two-thirds of respond-ents reported a decline in procedures to implant mesh slings; forty percent reported a decline in mesh sacrocolpopexy; and 40% and 50% reported an increase in explantations of mesh used for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) respectively. Contributing factors for SUI procedure changes were patient preference (83%) and litigation concerns (59%), for POP procedures it was mesh non-availability (81%). Clinician responses included changing to other procedures (SUI 54%; POP 71%); conservative management (SUI 17%); and upskilling and onward referral (14%, 10%) for POP. Responses varied by specialty group. A majority recommended adding native tissue SUI procedures to the APFPR.
Conclusion The survey provides insights into the impact and implications of the reduction in pelvic prostheses over the last 5 years. The addition of native tissue SUI procedures to the APFPR will ensure it maintains clinical relevance in a changing landscape.