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Risk factors for recurrence after hysterectomy plus native-tissue repair as primary treatment for genital prolapse

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Abstract

Introduction and hypothesis

Identification of risk factors for pelvic organ prolapse (POP) recurrence is crucial to provide adequate preoperative counselling and tailor surgical treatment. The aim of this retrospective study was to identify risk factors for recurrence in a large series of patients with POP treated with primary transvaginal native-tissue repair involving high uterosacral ligament suspension.

Methods

Postoperative descent of POP-Q stage 2 or higher in any compartment was considered as recurrence. Global recurrence (GR) was defined as any recurrence in any compartment irrespective of the surgical procedures performed during primary prolapse surgery. True recurrence (TR) was defined as recurrence in a compartment repaired during primary prolapse surgery.

Results

Of a total of 533 eligible women, 519 were available for follow-up. Univariate analysis showed that age ≤50 years, premenopausal status, obesity (BMI >30 kg/m2), history of severe macrosomia (>4,500 g), preoperative POP stage 3 or higher and absence of anterior repair at the time of POP surgery were risk factors for GR. Multivariate analysis confirmed lack of posterior repair (odds ratio, OR, 1.8), severe macrosomia (OR 2.7), premenopausal status (OR 3.9), obesity (OR 2.2) and preoperative stage 3 or higher (OR  2.6) as risk factors for GR. Univariate analysis showed that premenopausal status and preoperative POP stage 3 or higher were risk factors for TR. Multivariate analysis confirmed premenopausal status (OR 4.0) and preoperative stage 3 or higher (OR 4.5) as risk factors for TR.

Conclusions

This study confirmed preoperative stage 3 or higher as a risk factor for prolapse recurrence. The study also identified additional risk factors for surgical failure including lack of posterior repair, severe macrosomia, premenopausal status and obesity.

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Authors and Affiliations

  1. ASST Monza, U.O. Ginecologia, Ospedale San Gerardo, Via Pergolesi, 33 - 20900, Monza, MB, Italy

    Stefano Manodoro, Matteo Frigerio, Alice Cola & Rodolfo Milani

  2. Università degli Studi di Milano-Bicocca, Milan, Italy

    Matteo Frigerio, Alice Cola, Federico Spelzini & Rodolfo Milani

  3. AUSL Romagna, Ospedale Infermi, Rimini, Italy

    Federico Spelzini

Authors
  1. Stefano Manodoro
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  2. Matteo Frigerio
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  3. Alice Cola
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  4. Federico Spelzini
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  5. Rodolfo Milani
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Correspondence to Stefano Manodoro.

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Manodoro, S., Frigerio, M., Cola, A. et al. Risk factors for recurrence after hysterectomy plus native-tissue repair as primary treatment for genital prolapse. Int Urogynecol J 29, 145–151 (2018). https://doi.org/10.1007/s00192-017-3448-7

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  • DOI: https://doi.org/10.1007/s00192-017-3448-7

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