558 Materials and methods All members of the Dutch Urogynecologic Society received an e-mail explaining the research question and asking for their cooperation in an internet-based survey. A link in the e-mail directed them to a website containing an internet-based questionnaire. The first e-mail was sent in February 2010. A month later, a reminder was sent to the gynecologists who have not yet responded. A final reminder was sent by ordinary mail instead of an e-mail. The survey included 40 questions on demographics, current employment, and training background. To evaluate the diagnostic process, we asked if and how they differentiated between central and lateral defects and how this influenced their surgical technique. In addition, their use and opinion on the POP-Q score were questioned. Various questions on techniques used in surgical repair of a cystocele, use of prophylactic antibiotics, and preoperative and postoperative care were included. To identify the precise variation in surgical techniques, we asked about the use and type of solution used for hydrodissection, location and length of incision, technique of dissection, type of suture material, excision of excessive vaginal mucosa, and the way of suturing. Furthermore, questions were asked on postoperative care relating to the use of a catheter and vaginal packing and the day of removal. The survey was conducted anonymously. The respondents were assigned a number in order that reminders could be sent. No financial compensation was given. Data analysis was performed using Statistical Package for the Social Sciences, version 18.0 (SPSS Inc., Chicago, IL, USA). Continuous variables were compared using the independent-samples t test or Mann–Whitney U test. Categorical variables were compared using the chi-square test. Related samples were compared using the paired- samples t test or the Wilcoxon signed rank test. A p value of <0.05 was considered statistically significant. Results Diagnosis In total, 239 questionnaires were sent but 25 respondents did not belong to the target group (retired or resident). Nine questionnaires could not be delivered, leaving 133 respondents (65%). Respondents' characteristics are described in Table 1. Three-quarters of the participants (77%) responded that they use the POP-Q, of whom only 52% use routinely. There were no significant differences between the use of the POP-Q and practice type (p > 0.05). Thirty-two percent (n = 42) of the respondents differen- tiated between central and lateral defects. When they do, Int Urogynecol J (2011) 22:557–561 Table 1 Characteristics of survey respondents Characteristics Gender Male Female Years since residency <5 5–10 10–20 >20 Practice type Academic center Peripheral training hospital Peripheral, nontraining hospital n=133 (%) 60 (45) 73 (55) 45 (34) 29 (22) 31 (23) 28 (21) 12 (9) 77 (58) 44 (33) Data presented as number (percentage) differentiation between the two types is made by physical examination whereby the gynecologist usually inspects the presence of vaginal rugae. By the absence of rugae, a central defect is considered more likely. By the respondents who do differentiate between the two types, a change in operation procedure is however only seldom made. In case of a lateral defect, a small number of gynecologists (n = 14) perform an anterior colporrhaphy with graft augmentation. No vaginal or abdominal paravaginal repair was reported. Preoperative care All respondents use local hormone therapy from time to time in postmenopausal women; 58% use hormone therapy only when they diagnose vaginal atrophy. Routine perioperative antibiotics is given by 80 (60%) of the respondents. Technique of colporrhaphy Before the incision, 76% use hydrodissection, for which most commonly a saline solution is used with or without adrenaline (24% and 41%, respectively) (Table 3). Most respondents (77%) make a simple midline incision, although 17% make an inverted T-form incision from the cervix to the urethra. When the participants were asked for the most urethral point of incision, majority (56%) place the incision near the vesicoure- thral juncture, 19% 1 cm or less from the urethral meatus, and 11% below (proximal of) the vesicourethral juncture. To dissect the bladder, mainly scissors are used (43%), besides the knife (20%), blunt dissection (7%), or a combination of these techniques (30%). Furthermore, 43% of the participants attempt to dissect the vaginal mucosa as thin as possible from the bladder and 47% consider thickness less important and dissect in the most optimal surgical plane.