560 defect is an interesting and potentially important issue. With the availability of new diagnostic possibilities such as MRI and ultrasound, as well as new surgical techniques using synthetic grafts, new possibilities for the differentiation and tailoring the right operation to the right patient are becoming available [10–12]. At present, a study on the validity of MRI and ultrasound for this purpose is being performed in the Netherlands [12]. The use of the vaginal paravaginal repair was remarkably low in our question- naire, since only two gynecologists reported to consider vaginal paravaginal repair for lateral defects. No respondent reported the use of abdominal paravaginal repair. This is in sharp contrast with the recommendation given in the report from the last International Continence Initiative (ICI, 2009) where the abdominal route has been advised [13]. Possibly, the use of paravaginal repair in the Netherlands has remained low because of the disappointing results from earlier studies [3, 14]. The use of synthetic grafts was not part of the present study. At present, it is advised by the Dutch Urogyneco- logic Society not to use grafts in primary surgery. Another potentially important item is the dissection of the vaginal mucosa from the underlying tissue. Practices were divided regarding this issue. Older textbooks use the term “as thin as possible” in the description of the traditional colporrhaphy [15]. In the more recent literature, this is not mentioned [15, 16]. However, there is no scientific evidence on the best dissection of vaginal mucosa. We hypothesized that making the vaginal mucosa as thin as possible was something of “a lost art" and therefore practiced by older gynecologists, but this could not be confirmed in our study (p = 0.56). Possibly, it is more relevant how and where the gynecologist was trained, but this was not part of our questionnaire. We think that thinness of preparation is a potential important issue, which should be studied, preferably in a well-designed random- ized controlled trial. It was interesting to see that a number of practices are widely used without much evidence to support them. For example, three-quarters of the respondents used hydro- dissection before the incision with varying types of solution. Whether this practice has any advantage is not known. Almost two-thirds of the respondents used prophy- lactic antibiotics in anterior colporrhaphy. These findings are high in reflection of the lack of evidence with regards to this issue. There is only one single study, from Nieminen et al., which has reported that prophylactic use of antibiotics seemed effective in the reduction of the postoperative infection rate in vaginal surgery [17]. Almost half of the respondents removed the transurethral catheter on day 2 after surgery. However, two randomized trials have found that in case of removal of the catheter on the morning after surgery, the majority of the patients do Int Urogynecol J (2011) 22:557–561 not encounter voiding problems [18, 19]. Furthermore, two studies have shown that 3 h of vaginal packing would be as sufficient for the prevention of postoperative hemorrhage or hematoma as vaginal packing for 24 h [20, 21]. Therefore, it is somewhat surprising that 95% of the respondents remove the vaginal pack 1 day after surgery. The findings that the POP-Q score is not widely used suggest that the POP-Q score does not meet the doctor's needs, which are in line with earlier publications [22]. Less than half of those surveyed use the score routinely. The measurement of redundant parameters is the most common comment on the POP-Q score. A quarter of the participants find the POP-Q score a time-consuming task. Surprisingly, there was no statistical difference in the use of POP-Q score between gynecologist from academic, peripheral training, and nontraining hospital. We recognize several limitations of this study. A survey is always a simplification of the reality. It is impossible to question all minor details of the surgical technique, which will be influenced by various details of the surgical anatomy and expertise of the surgeon. Another important issue is that from this study, we are not able to analyze which technique leads to a higher recurrence. We did not specifically ask for the recurrence rates in our questionnaire because of a low reliability of the answers without objective outcome measures. A strength of this study is that 65% of all members of the Dutch Urogynecologic Society responded to the questionnaire. This study has raised many research questions in need of further investigation. The variation of techniques used is a reflection of the absence of a clearly defined best practice. A well-designed prospective study investigating the differ- ences in techniques with special attention to differentiation between lateral and central defects is clearly lacking. In conclusion, we found a wide variation of techniques used for anterior colporraphy in the Netherlands. We consider the lack of differentiation between central and lateral defects the most striking finding, which should be further studied in a prospective study. Conflicts of interest None. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506 2. Weber AM, Walters MD (1997) Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol 89:311–318