Int Urogynecol J (2011) 22:557–561 Table 2 presents the specifications of the suture material used for plication of the (remnants of) the vaginal fascia. For closure of the vaginal wall, opinions were divided: 32% used simple interrupted stitches, 32% used a continuous locking stitch, and 35% of the respondents used a running (nonlocking) stitch. Excessive distended vaginal epithelium is trimmed by 51% of the respondents depending on the amount of tissue, 4% never trim vaginal epithelium, and 45% always do so (Table 3). Postoperative care The catheter is generally inserted transurethrally (97%), and the day of catheter removal was day 1 (24.8%), day 2 (45.1%), day 3 (29.3%), or later (1%). After removal of the catheter, the accepted residue in the bladder was 150 cc (52.6%) or 100 cc (36.1%). Most of the respondents (85.0%) insert a vaginal pack as a standard procedure, and they almost universally remove it 1 day after surgery (94.7%). Patients were discharged on average on days 2 and 3 (30.8% and 54.1%, respectively). No statistically significant differences were found in the comparisons between the characteristics of the survey respondents [gender, years since residency, and practice type (academic versus nonacademic)] and the technique of the anterior colporrhaphy or preoperative and postoperative care (p > 0.05). No geographic variations could be found. Discussion Our findings demonstrate that gynecologists use a variety of surgical techniques to treat a cystocele. This suggests that there is no clear opinion with regards to the best Table 2 Specifications of the suture materials and method for plication Suture material Vicryl® (polyglactin 910) Monocryl® (poliglecaprone 25) Thickness suture material 1 0 2-0 3-0 Plication in anterior colporrhaphy Simple interrupted stitches Continuous locking stitches Running stitches Data presented as number (percentage) n=133 (%) 130 (98) 3 (2) 7 (5) 8(6) 113 (85) 5 (4) 43 (32) 43 (32) 47 (35) 559 n=133 (%) 101 (76) 32 (24) 41 (41) 24 (24) 2 (2) 34 (34) 27 (20) 57 (43) 9 (7) 40 (30) 60 (45) 68 (51) 5 (4) Table 3 Technique of colporrhaphy Hydrodissection Yes No Type of hydrodissection (n=101) Saline Saline with adrenaline Local anesthetic Local anesthetic with adrenaline Dissection bladder Knife Scissors Blunt dissection Combination Trimming of excess vaginal epithelium Always Depends on the amount of tissue Never Data presented as number (percentage) surgical procedure. Only one other similar study was found in the literature, however with a low response rate [4]. In that study, members of the AUGS reported a comparable high variation in techniques. The wide variation in techniques may be a consequence of the lack of evidence as to what the best practice is. It is unknown which part of the procedure (diagnosis, preoperative, perioperative, or postoperative care) contributes to surgical failure. Our study shows that there is little difference with regards to items such as use of a vaginal packing, transurethral catheter, and the day of their removal. Likewise, factors such as length of incision, suturing techniques, and suture material are either quite similar or unlikely to have a great impact on recurrence. Several other items, however, emerge as potentially important with regard to the explanation for the high recurrence rates. Majority of the gynecologists do not differentiate between central and lateral defects nor is there any adjustment in the surgical technique to address this issue. We are not aware of any earlier studies in other countries on data for comparison. Most literature on the differences between the two defects originates from the USA [7, 8]. Although several tests to differentiate have been proposed, these tests have never been validated or been incorporated in an outcome study. Furthermore, the clinical examination of defects in the anterior vaginal wall support displays poor interexaminer and intraexaminer agreement [9]. In other words, it is unclear how to differentiate between the two and it has never been shown that differentiation results in a better outcome. Nonetheless, theoretically, the location of a