National Survey on the Management of Genital Prolapse in Italy

Matteo Frigerio,1 Andrea Morciano,2 Marta Barba,1 Michele Carlo Schiavi,3 Alice Cola,1 Elena Cavaliere,4 Carlo Rappa,5 Mauro Cervigni6 On behalf of the “Young Commission” of the Italian Association of Urological Gynecology and Pelvic Floor (AIUG)1Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; 2Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione “Cardinale G. Panico”, Tricase, Italy; 3Department of Gynaecology and Obstetrics, “Sandro Pertini” Hospital, Roma, Italy; 4Department of Gynecology and Obstetric B, Ospedale Della Donna E Del Bambino, Verona, Italy; 5Centro PelviCare “Clinica Villa Angela”, Napoli, Italy; 6Department of Urology, Università “la Sapienza”, ICOT, Latina, ItalyCorrespondence: Marta Barba, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi, 33, Monza, 20900, Italy, Tel +0392339434, Email [email protected]: Surgical repair is considered the mainstay of genital prolapse management. Several procedures are available both by vaginal and abdominal route, with and without mesh augmentation. The Italian UroGynecology Association (AIUG) promoted this survey with the aim of evaluating current variations in the surgical management of various types of prolapse in different clinical settings and to compare practice amongst practitioners working in high- and medium/low-volume centers.Participants and Methods: The questionnaire examined four contentious areas of contemporary prolapse management. The questionnaire was emailed to the AIUG gynecologist members in Italy in 2023.Results: A total of 104 complete responses were received, resulting in a 6.9% response rate. Native-tissue repair represents the preferred option in most scenarios and was proposed by 76%, 68.3%, 94.2%, and 52.9% of practitioners in the case of primary anterior, uterovaginal, posterior, and vault prolapse respectively. The use of vaginal mesh in these scenarios is very limited. Native tissue repairs in case of recurrent anterior, posterior, or apical recurrent prolapse would be performed only by 37.5%, 47.1%, and 28% of surgeons respectively. In these cases, the use of mesh - by vaginal and abdominal route - increased significantly.Conclusion: This survey showed that in Italy surgical management of genital prolapse is very heterogeneous. Native-tissue repair remains the preferred option, but practitioners tend to lose confidence in mesh-free procedures in case of prolapse recurrence. Despite mesh kits recalls and recommendations, the use of transvaginal implants is still considered an option for prolapse repair.Keywords: pelvic floor, pelvic organ prolapse, survey, surgery, management, urogynecology