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Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery

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Abstract

The objective of this study was to determine the factors associated with the anatomic and functional recurrence of prolapse. An examination was performed in 134 of the 228 patients who underwent primary vaginal surgery for prolapse of the pelvic organs (POP) between 2000 and 2001. Anatomical recurrence of the prolapse was established by pelvic examination using the pelvic organ prolapse quantification (POPQ) staging system. Functional results were obtained by interview with the patients. Descriptive statistical analyses and multivariate logistic regression were performed to determine the factors associated with recurrence. Five years after surgery, 42 women (31.3%) presented anatomical recurrence of the prolapse (grade ≥ II), and only 10 of the 134 (7.4%) had prolapse-related symptoms. Those with high body weight (>65 kg) and younger women (<60 years) were associated with an increase in the risk for both anatomical and functional recurrence. Advanced preoperative prolapse (grade III–IV) of any compartment was associated with anatomical failure but not with symptomatic recurrence. There was a poor correlation between anatomical and symptomatic recurrence. Younger women and those with a higher body weight are more likely to experience recurrent prolapse after vaginal repair.

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Abbreviations

POP:

pelvic organ prolapse

OR:

odds ratio

CI:

confidence interval

POPQ:

pelvic organ prolapse quantification

ICI:

International Continence Society

BMI:

body mass index

References

  1. Beck RP (1983) Pelvic relaxational prolapse. In: Kase NG, Weingold AB (eds) Principles and practice of clinical gynaecology. Wiley, New York, pp 677–685

    Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom Jo, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506

    Article  PubMed  CAS  Google Scholar 

  3. Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, Wang W, Schaffer J (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192:795–806

    Article  PubMed  Google Scholar 

  4. Bump R, Norton PA (1998) Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am 25:723–746

    Article  PubMed  CAS  Google Scholar 

  5. Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the women’s health initiative: gravity and gravidity. Am J Obstet Gynecol 186:1160–1166

    Article  PubMed  Google Scholar 

  6. Progetto Menopausa Italia Study Group (2000) Risk factors for genital prolapse in non-hysterectomized women around menopause. Results from a large cross-sectional study in menopausal clinics in Italy. Eur J Obstet Gynecol Reprod Biol 93:135–140

    Article  Google Scholar 

  7. Gill EJ, Hurt WG (1998) Urogynecology and pelvic floor dysfunction. Obstet Gynecol Clin North Am 25:757–769

    Article  PubMed  CAS  Google Scholar 

  8. Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113:225–230

    Article  PubMed  CAS  Google Scholar 

  9. Burgio K, Clark A, Lapitan MC, Nelson R, Sillén U, Thom D (2004) Epidemiology of urinary (IU) and faecal (FI) incontinence and pelvic organ prolapse (POP). In: 3rd International Consultation on Incontinence (ICI). Paris, France, pp 257–312

  10. Clark A, Gregory T, Smith V, Edwards R (2003) Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 189:1261–1267

    Article  PubMed  Google Scholar 

  11. Schull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183:1365–1374

    Article  Google Scholar 

  12. Whiteside J, Weber A, Meyn LA, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 191:1533–1538

    Article  PubMed  Google Scholar 

  13. Tegerstedt G, Hammarström M (2004) Operation for pelvic organ prolapse: a follow-up study. Acta Obstet Gynecol Scand 83:758–763

    Article  PubMed  Google Scholar 

  14. Vakili B, Zheng YT, Loesch H, Echols KT, Franco N, Chesson RR (2005) Levator contraction strength and genital hiatus as risk factors for recurrent pelvic organ prolapse. Am J Obstet Gynecol 192:1592–1598

    Article  PubMed  Google Scholar 

  15. Baden WF, Walter TA, Lindsay HJ (1968) The vaginal profile. Tex Med J 64:56–58

    CAS  Google Scholar 

  16. Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S (2005) P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 16:176–181

    Article  PubMed  Google Scholar 

  17. Swift SE, Herring MD (1998) Comparison of pelvic organ prolapse in the dorsal lithotomy versus the standing position. Obstet Gynecol 91:961–964

    Article  PubMed  CAS  Google Scholar 

  18. Bump RC, Mattiason A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  PubMed  CAS  Google Scholar 

  19. Laycock J (1991) Incontinence. Pelvic floor re-education. Nursing (Lond) 4(39):15–17

    CAS  Google Scholar 

  20. Norton P (2006) New technology in gynecology surgery. Is new necessary better? Obstet Gynecol 108(3 Pt 2):707–708

    PubMed  Google Scholar 

  21. Baessler K, Maher CF (2006) Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits. Curr Opin Obstet Gynecol 18:560–566

    Article  PubMed  Google Scholar 

  22. Chiaffarino F, Chatenoud L, Dindelli M, Meschia M, Buonaguidi A, Amicarelli F, Surace M, Bertola E, Di Cintio E, Parazzini F (1999) Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol 82:63–67

    Article  CAS  Google Scholar 

  23. Mant J, Painter R, Vessey M (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study. Brit J Obstet Gynecol 104:579–585

    CAS  Google Scholar 

  24. DeLancey JO (2005) The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 192:1488–1495

    Article  PubMed  Google Scholar 

  25. MacLennan AH, Taylor AW, Wilson DH (2000) The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Brit J Obstet Gynecol 107:1460–1470

    CAS  Google Scholar 

  26. Handa V, Garrett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 19t:27–32

    Article  Google Scholar 

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Acknowledgment

We thank Dra. Cristina Sarasqueta of the Statistics and Epidemiology Department of Donostia Hospital for the help with statistics and also for her lessons in the use of the SPSS program. Furthermore, we are very grateful to Dra. Montserrat Espuña of the Institut Clinic of Gynecology, Obstetrics and Neonatology. Clinic Hospital in Barcelona for the review of the present manuscript.

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  1. I. Diez-Itza

    Present address: , Paseo de Ondarreta No.1, 5C, 20008, San Sebastian, Guipuzcoa, Spain

Authors and Affiliations

  1. Departamento de Obstetricia y Ginecología Secretaria Ginecología, Planta no.4, Edificio Materno-Infantil, Hospital Donostia, Paseo Beguiristain, 107-115, 20014, San Sebastian, Guipuzcoa, Spain

    I. Diez-Itza, I. Aizpitarte & A. Becerro

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  1. I. Diez-Itza
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  2. I. Aizpitarte
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  3. A. Becerro
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Correspondence to I. Diez-Itza.

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Diez-Itza, I., Aizpitarte, I. & Becerro, A. Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J 18, 1317–1324 (2007). https://doi.org/10.1007/s00192-007-0321-0

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  • DOI: https://doi.org/10.1007/s00192-007-0321-0

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