Obstetrics and Gynecology International primary and recurrent POP repair, as well as for POP repair in patients presenting with concomitant disease, menopause, or lifestyle considerations. Importantly, in women desiring preservation of fertility, there appears to be a marked increase in the use of mesh in hysteropexy, which may reﬂect on increase in documentation of favorable results pertaining to pregnancy [7, 8]. The reported increase in the use of colpocleisis may result from current training of physicians, and increased caution by urogynecologists regarding possible mesh complications in the elderly population. The use of vaginal meshes in POP repair has increased in Israel despite the lack of randomized controlled trials supporting such use, and despite seemingly unresolved legal complications regarding the extent of patients’ consent. The latter issue is not merely a technicality—long-term stability and risks of complications from these procedures are as yet unknown. Nevertheless, the reasons for the growing popularity of vaginal mesh are varied. First, Israeli surgeons practice medicine in an environment characterized by innovation and scientiﬁc progress, exempliﬁed by Israel’s reputation as a world leader of biotechnological research and development. Second, the boon of new mesh products, accompanied by powerful marketing eﬀorts, has made a wide array of vaginal mesh products available to surgeons. Third, experience and mastery of the use of vaginal meshes may alleviate previous reservations in favor of the new technology. Fourth, and perhaps of prime importance, the ease of use of the new mesh products, along with physicians’ own experience about better durability in POP repair with mesh compared with native tissue, is making them lucrative for most gynecologists. The use of a nonvalidated questionnaire is a limitation of the current study. Further, its anonymity precluded assessment of such characteristics of urogynecologists as number of years in practice and place of training. Most importantly, we have no data regarding the number of vaginal mesh procedures that were actually performed by each gynecologist, which may constitute a reporting bias on the part of the respondents. 6. Conclusion The survey reported herein demonstrates a recent increase in the popularity of vaginal mesh use for the repair of pelvic organ prolapse among Israeli urogynecologists. Randomized controlled trials of the use of vaginal mesh for POP repair are needed to determine optimal indications for their use. In the meantime, caution should be advised in the application of this yet unproven technology [4]. Appendix Survey Questionnaire Questions 1–3 pertain to women referred due to stage 3 prolapse of at least one compartment. Always Never 5 4 3 2 1 0 (p1r)imUasreyoPf OvaPgirneaplamir esh in 5 4 3 2 1 0 r(e2c)uUrrseenotfPvOagPinraelpmairesh in 5 4 3 2 1 0 (3) Would you use a vaginal dmiseisnhteinreastpedatiinenstexwuhaol is 5 4 3 2 1 0 intercourse? (4) Would you use a vaginal mesh in women over 70 years 5 4 3 2 1 0 of age? (5) Do you consider insulin cdoenpternadinenditcdaitaiobnetteos mvaeglilnitauls a 5 4 3 2 1 0 mesh use? (6) In a menopausal patient with a stage III prolapse of one vaginal wall and stage II 5 4 3 2 1 0 uterine prolapse, would you prefer to preserve the uterus? (7) In a menopausal patient with stage I uterine prolapse and stage III elongation of 5 4 3 2 1 0 uterine cervix, would you prefer to preserve the uterus? (8) A healthy, physically, and sexually active 55 year old. Diagnosis: stage III uterine prolapse, stage III cystocele, gaping introitus, stress urinary incontinence. Your choice of procedure: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (9) A healthy 80-year-old patient who is not sexually active. Diagnosis: total prolapse. Your choice of procedure: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (10) A 35-year-old woman desiring preservation of fertility. Diagnosis: stage III uterine prolapse, stage II cystocele, stage II rectocele (pessary treatment failed). Your choice of procedure: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 References [1] B. Feiner, J. E. Jelovsek, and C. Maher, “Eﬃcacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review,” International Journal of Obstetrics and Gynaecology, vol. 116, no. 1, pp. 15–24, 2009. [2] C. Maher, B. Feiner, K. Baessler, E. J. Adams, S. Hagen, and C. M. Glazener, “Surgical management of pelvic organ prolapse in women,” Cochrane Database of Systematic Reviews, vol. 4, Article ID CD004014, 2010. [3] M. Murphy, “Clinical practice guidelines on vaginal graft use from the society of gynecologic surgeons,” Obstetrics and Gynecology, vol. 112, no. 5, pp. 1123–1130, 2008. [4] V. W. Sung, R. G. Rogers, J. I. Schaﬀer et al., “Graft use in transvaginal pelvic organ prolapse repair: a systematic review,” Obstetrics and Gynecology, vol. 112, no. 5, pp. 1131–1142, 2008. [5] S. J. Mucowski, C. Jurnalov, and J. Y. Phelps, “Use of vaginal mesh in the face of recent FDA warnings and litigation,” American Journal of Obstetrics and Gynecology, vol. 203, no. 2, pp. 103.e1–103.e4, 2010.