International Urogynecology Journal

, Volume 29, Issue 1, pp 13–21 | Cite as

Risk factors for prolapse recurrence: systematic review and meta-analysis

  • Talia FriedmanEmail author
  • Guy D. Eslick
  • Hans Peter Dietz
Review Article


Introduction and hypothesis

Female pelvic organ prolapse (POP) is a common condition, with a lifetime risk for surgery of 10–20%. Prolapse procedures are known to have a high reoperation rate. It is assumed that etiological factors for POP may also be risk factors for POP recurrence after surgery. There are few reviews available evaluating risk factors for prolapse and recurrence or recently updated meta-analysis on this topic. Our aim was to perform a systematic review and quantitative meta-analysis to determine risk factors for prolapse recurrence after reconstructive surgery.


Four electronic databases (MEDLINE, PubMed, EMBASE, and Google Scholar) were searched between 1995 and 1 January 2017, with no language restrictions.


Twenty-five studies met inclusion criteria for a total of 5082 patients with an average recurrence rate of 36%. Variables on which a meta-analysis could be performed were body mass index (BMI) (n = 12), age (n = 11), preoperative stage (n = 9), levator avulsion (n = 8), parity (n = 8), constipation/straining (n = 6), number of compartments involved (n = 4), prior hysterectomy (n = 4), familiy history (n = 3), and several other predictors evaluated in only three studies. The following meta- analyses identified significant predictors: levator avulsion [odds ratio (OR) 2.76, P < 0.01], preoperative stage 3–4 (OR 2.11, P < 0.001), family history (OR 1.84, P = 0.006), and hiatal area (OR 1.06/cm2, P = 0.003).


Levator avulsion, prolapse stage, and family history are significant risk factors for prolapse recurrence.


Avulsion Meta-analysis Pelvic organ prolapse Recurrence Risk factors Surgery 



This study was unfunded.

Compliance with ethical standards

Conflicts of interest

H.P. Dietz has received unrestricted educational grants from GE Medical. T. Friedman and G.D. Eslick have no conflict of interest to declare.


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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  1. 1.Sydney Medical School NepeanUniversity of SydneySydneyAustralia
  2. 2.Chaim Sheba Medical CenterTel Aviv UniversityTel AvivIsrael
  3. 3.The Whiteley-Martin Research Centre, Discipline of SurgeryThe University of SydneySydneyAustralia

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