Perineorrhaphy practice patterns

Current practice patterns for perineorrhaphy

Dear Colleague,

Thank you for your participation in this study. Please select the most appropriate answer that is applicable to you.

  1. What is your age?

25-30

31-35

36-45

46-60

>60

  1. What is your gender (check one)

Male

Female

  1. In order to allow us to avoid double sampling, what are the last 4 digits of your primary phone number______?
  1. How many years since you completed training?

 Still in training

  1. □Residency
  2. □Fellowship

0-5 years

6-10 years

 11-20 years

 >20 years

  1. In what geographic location is your practice located?

Northeast

Southwest

Midwest

Pacific/Northwest

Southeast

Canada

Outside North America (please specify)______

  1. What type of practice do you have?

Combined obstetrics and gynecology

Gynecology only

Urogynecology only

Urology Only

  1. Please indicate the setting of your primary practice (pick only one).

University-based or academic

Private practice or community based

Private with academic appointment

Managed care (i.e. Kaiser)

Research

Military

Other (please specify)______

  1. What type of formal training have you received (check all that apply)?

OB/Gyn residency

Urology residency

Urogynecology fellowship

Female Urology fellowship

Minimally invasive fellowship

Other (please specify)______

  1. How many perineorrhaphies do you perform per month?

I never perform perineorraphy

0-3

4-8

9-12

12-15

>15

  1. How many surgeries do you perform per month?

I never perform surgery

0-3

4-8

9-12

12-15

>15

  1. What percentage of the perineorrhaphies do you perform concurrently with other reconstructive surgery?

0-10%

11-20%

21-40%

41-70%

>70%

  1. Rate how important of each of the following factors are on when making your decision to perform a perineorrhaphy. Please rate each on scale of “Extremely important” to “Not at all important” by placing a check in the box that indicates your agreement.

Extremely Important / Very Important / Important / Somewhat Important / Not at all Important
  1. Concomitant procedure to decrease recurrence

  1. Intraoperative appearance

  1. Enlarged genital hiatus

  1. Small perineal body

  1. Anterior prolapse

  1. Posterior prolapse

  1. Apical prolapse

  1. Overall POPQ or Baden-Walker stage/grade

  1. Route of surgery (ie Abdominal vs. Vaginal)

  1. As the sole reason for surgery

  1. Improving sexual function due to laxity

  1. Improving sexual function due to posterior introitus dyspareunia

  1. Not sexually active

  1. Patient request

  1. Cosmetic appearance to patient

  1. Prior failed reconstruction

  1. When is the decision made to include perineorrhaphy as part of the surgery?

In the office after discussion with the patient

In the OR after exam under anesthesia

At the end of the other procedure(s) being done

  1. Do you think perineorrhaphy improves sexual function?

 Never

Occasionally

Sometimes

Usually

Always

  1. Do you think perineorrhaphy causes dyspareunia?

Never

Occasionally

Sometimes

Usually

Always

  1. When you perform a periniorrhaphy, which structures do you reapproximate (select ALL that apply):

Bulbocavernosis individually

Transverse perineal muscle individually

Bulbocavernosis and transverse perineal muscle together

Levator muscles

Rectovaginal septum to perineal body

  1. Does your repair take place (choose only one):

 Distal to the hymen

 Proximal to the hymen

 Both proximal and distal to the hymen

Distal to the introitus

Proximal to the introitus

Both distal and proximal to the introitus

  1. Which suture type do you prefer for a perineorrhaphy?

 Monofilament

Polyfilament

  1. Which suture caliber do you prefer?

 0

 1-0

 2-0

 3-0

 4-0

  1. Is it your practice to routinely close the perineal skin at the end of the procedure?

Yes

No

  1. Do you consider a repair after an obstetrical laceration a perineorrhaphy?

Yes

No

Scenarios: Would you perform a perineorrhaphy for the patients in the following scenarios?

  1. A 85 yo with procidentia with plans to undergo colpocleisis, with attenuated perineal body (PB=2) and relaxed introitus (GH=5)?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 42 yo F with stage 3 anterioapical pelvic organ prolapse with plans to undergo a endoscopic or abdominal supracervical hysterectomy and sacrocolpopexy, with an attenuated perineum, but no complaints about appearance or sexual function?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 62 yoF with plans to undergo a transvaginal hysterectomy, uterosacral ligament suspension, with no significant vaginal laxity, normal appearing introitus and perineal body, no complaints of sexual dysfunction or problems with appearance?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 62 yo F with plans to undergo a total vaginal hysterectomy, uterosacral ligament suspension, with an attenuated perineal body and relaxed introitus, no complaints of sexual dysfunction or problems with appearance?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 72 yo F with an isolated symptomatic anterior compartment prolapse of POP-Q stage 3, extending 3cm beyond the hymen, with an in-tact perineal body, who is sexually active?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 67 yo F who is s/p hysterectomy 10 years ago with isolated proximal rectocele extending 2cm beyond the hymen, with an otherwise normal appearing perineal body and introitus?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 37 yo G3P3 who has completed childbearing, with complaints that she has decreased capacity for orgasm since her last delivery, with a relaxed introitus (GH=5)?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 39 yo G4P4with vaginal laxity (GH=6) and her husband has complained that she feels “less tight” than when they first met, which has decreased his satisfaction during sex? Otherwise they appear to have a very healthy relationship to the best you can tell.

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

  1. A 45 yo G3P3 with some decreased sexual desire, who feels unhappy with the appearance of her vagina due to it appearing “more open” than before, but feels uncomfortable discussing this with her husband?

1

Perineorrhaphy practice patterns

Yes

Most likely

Probably not

No

1

Perineorrhaphy practice patterns

1