Current practice of colposuspension in the United Kingdom: Results of a national survey

Abstract

Introduction: Colposuspension procedures have increased in the UK following the 2018 suspension of vaginal mesh for stress urinary incontinence. However, significant variation exists in preoperative assessment, patient selection, surgical approach, and postoperative care. This survey aims to explore current national practice.

Material and Methods: A questionnaire was distributed to members of the British Society of Urogynaecology (BSUG) and the British Association of Urological Surgeons (BAUS).

Results: Fifty-three clinicians responded; most were gynecologists with a special interest in urogynecology (60%) or urogynecology subspecialists (34%). Response rates were 12% (51/442) among BSUG members and <1% (2/2622) among BAUS members. Annual case volume was 5 to 10 for 43%, fewer than 5 for 36%, 10–20 for 19%, and >20 for 2%. Most surgeons (85%) perform preoperative urodynamics in all patients, while 15% restrict testing to women with mixed symptoms. Almost all (98.1%) would treat detrusor overactivity or symptomatic overactive bladder prior to offering colposuspension. Forty-five percent will perform colposuspension at any functional or maximum cytometric capacity; others use cutoffs of >400 mL (19%), >300 mL (26%) or >200 mL (10%). Fifty-five percent reported a BMI limit of <35, while 19% have no limit. Most surgeons favored an open approach (58%), followed by laparoscopic (38%) and robotic (4%). Sutures were usually suspended tension-free (75%) using Ethibond (53%) or PDS (40%), with 72% consenting for the use of non-absorbable sutures. For open colposuspension, two sutures bilaterally were preferred (49%), followed by three (40%) and four (11%). Laparoscopic or robotic procedures were mostly intra-peritoneal (89%), with surgeons placing two sutures bilaterally (88%) and tying their knots extracorporeally (75%). Thirty-nine percent close the peritoneum over their sutures. Routine check cystoscopy was performed by 60%. Postoperatively, indwelling urinary catheters are mostly left on free drainage (69%); 17% always use a suprapubic catheter and 4% preferred clean intermittent self-catheterization. Trial without catheter is most commonly attempted on Day 1 post-colposuspension (74%), with variable voiding criteria and acceptable post-void residuals.

Conclusion: This national survey highlights marked heterogeneity in UK colposuspension practice. There is a need for comparative studies and national consensus on core technical steps to ensure safety and favorable long-term outcomes.