Management of Anterior Vaginal Prolapse in South Africa--Results of a National Survey (Research‪)‬

Among parous women, the prevalence of pelvic organ prolapse (POP) is 50%, with an increase with advancing age. (1) The lifetime risk of surgery for urinary incontinence or POP has been estimated at approximately 11%, with 30% needing a second operation within 2 years. (2) Anterior vaginal prolapse is the most common type of POP and can have a significant impact on a woman's quality of life. (3,4) It has been defined as pathological descent of the anterior vaginal wall and overlying bladder base. The International Continence Society (ICS) standardised the terminology for prolapse grading, and recommended the term 'anterior vaginal prolapse' for what was traditionally known as 'cystocele'. (5) Most women with anterior vaginal prolapse are asymptomatic, symptoms only tending to arise once the leading part of the prolapse extends past the hymeneal ring. (6) Most common symptoms are a poor stream, incomplete emptying of the bladder and an overactive bladder. The main problems surrounding anterior vaginal prolapse are a high failure rate for surgery and hence controversy regarding the best method of treatment. A wide variation of 20-70% for recurring prolapse following surgery has been reported. (7,8) Most of these procedures were done without the use of synthetic mesh. Although the use of synthetic mesh may be associated with problems such as de novo overactive bladder symptoms and mesh erosion, the incidence of recurrent prolapse at approximately 1 year's follow-up seems to be lower, usually below 20%.9 The important point is that there is no generally agreed upon standard method for the surgical correction of anterior vaginal prolapse. The aim of this study was therefore to survey the methods used in evaluating and treating this form of prolapse in South Africa.