Nationwide trends in physician consultation and surgical management for pelvic organ prolapse in Japan, 2014 to 2024: a health insurance claims database analysis.

Abstract

<h4>Background</h4>Pelvic organ prolapse (POP) is a common disease that substantially impairs women's quality of life. Nationwide data on the proportions of physician consultations and surgical management of POP in Japan are not available. Furthermore, surgical approaches, including minimally invasive surgeries, have diversified in recent years; however, the extent of their application and potential regional disparities in each procedure have not been evaluated at the national level.<h4>Objective</h4>To visualize the 10-year trends in the diagnosis and surgical procedure selection for POP in Japan from 2014 to 2024 and examine the regional variations in the selection of surgical procedures.<h4>Study design</h4>This nationwide descriptive study used data extracted from the DeSC database, which is a repository of Japanese health insurance claims data.<h4>Results</h4>The proportion of patients with POP among all women aged 40 years or above in the database was 1.47% (112,775/7660,925; 95% confidence interval [CI]: 1.46%-1.48%). A total of 16,752 patients underwent surgery at least once, and the prevalence of surgery was 14.85% (16,752/112,775; 95% CI: 14.65%-15.06%). The rate of surgery was 53.3 per 1000 person-years. Among women diagnosed with POP, the proportion of hysterectomy with vaginal wall repair and transvaginal mesh surgery decreased after the introduction of insurance coverage for laparoscopic sacrocolpopexy (LSC) in 2016. Robot-assisted sacrocolpopexy (RSC) partially replaced LSC since gaining insurance coverage in 2020. Urethral sling surgery was the most frequently performed second surgery. Regional differences were observed in the proportions of consultations and surgical rates. The proportion of procedures chosen as initial surgery differed across regions; the implementation rates of vaginal vault suspension and RSC exhibited particularly large regional disparities.<h4>Conclusion</h4>This study offers valuable evidence to enhance patient education on POP in Japan and help mitigate regional inequalities in insured healthcare services.