International Urogynecology Journal

, Volume 30, Issue 11, pp 1945–1953 | Cite as

Incidence and contributing factors of perioperative complications in surgical procedures for pelvic organ prolapse

  • Hanan AlshankitiEmail author
  • Sara Houlihan
  • Magali Robert
  • Calgary Women’s Pelvic Health Research Group
Original Article



Data on the incidence of perioperative complications of surgical procedures for pelvic organ prolapse (POP) and their contributing factors are limited, sometimes conflicting, and often mixed with other urogynecologic surgeries.


To estimate the incidence and contributing factors for perioperative complications of POP procedures.


A cross-sectional study was carried out between November 2016 and June 2017. POP procedures of different approaches were included irrespective of the surgeon involved, type of surgery (primary or repeat), or concomitant hysterectomy or incontinence repair. Data on perioperative complications were recorded prospectively.


A total of 366 women were included in the current analysis. The average age was 61.0 ± 13.4 years. The surgical procedures performed were vaginal (75.3%), abdominal (11.3%), or combined (13.4%). Approximately 18.2% of these procedures were repeat surgeries. A total of 38 (11.3%) women developed perioperative complications (3.6% severe and 7.7% minor). These included: 25 (7.4%) intraoperative complications (2.4% severe and 5.1% minor) and 17 (5.1%) postoperative complications (2.1% severe and 3.0% minor). In multivariate analysis, abdominal surgery and McCall culdoplasty were significant predictors of intraoperative complications (alone or when combined with other postoperative complications). On the other hand, concomitant hysterectomy and concomitant incontinence repair procedure were associated with higher postoperative complication rates while vaginal surgery had fewer postoperative complications.


There was a low rate of perioperative complications. Abdominal surgery and McCall culdoplasty showed higher intraoperative complications. These data should help in preoperative counseling and target ways to further decrease complication rates.


Pelvic organ prolapse Urogynecology Surgical complications Incidence 



The authors wish to thank the Calgary Women’s Pelvic Health Research Group


This project has been funded by the section of Pelvic Medicine and Reconstructive Surgery.


  1. 1.
    Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.CrossRefGoogle Scholar
  2. 2.
    Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.CrossRefGoogle Scholar
  3. 3.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.CrossRefGoogle Scholar
  4. 4.
    Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127–35.CrossRefGoogle Scholar
  5. 5.
    Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396–403.CrossRefGoogle Scholar
  6. 6.
    Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73.CrossRefGoogle Scholar
  7. 7.
    Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.CrossRefGoogle Scholar
  8. 8.
    Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003;188(1):108–15.CrossRefGoogle Scholar
  9. 9.
    Boyles SH, Weber AM, Meyn L. Procedures for urinary incontinence in the United States, 1979-1997. Am J Obstet Gynecol. 2003;189(1):70–5.CrossRefGoogle Scholar
  10. 10.
    Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184(7):1496–501. discussion 1501-1493.CrossRefGoogle Scholar
  11. 11.
    Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The collaborative review of sterilization. Am J Obstet Gynecol. 1982;144(7):841–8.CrossRefGoogle Scholar
  12. 12.
    Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S. Predicting risk of complications with gynecologic laparoscopic surgery. Obstet Gynecol. 1998;92(3):327–31.PubMedGoogle Scholar
  13. 13.
    Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50(11):795–805.CrossRefGoogle Scholar
  14. 14.
    Lambrou NC, Buller JL, Thompson JR, Cundiff GW, Chou B, Montz FJ. Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery. Am J Obstet Gynecol. 2000;183(6):1355–8. discussion 1359-1360.CrossRefGoogle Scholar
  15. 15.
    Cengiz H, Dagdeviren H, Kaya C, Helvacoğlu Ç, Ekin M. Perioperative complications of urogynecologic surgery: our experience in a tertiary care hospital. Gynecol Obstet Reprod Med. 2017:1–3.Google Scholar
  16. 16.
    Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol. 2005;192(5):1630–6.CrossRefGoogle Scholar
  17. 17.
    Bohlin KS, Ankardal M, Nussler E, Lindkvist H, Milsom I. Factors influencing the outcome of surgery for pelvic organ prolapse. Int Urogynecol J. 2018;29(1):81–9.CrossRefGoogle Scholar
  18. 18.
    Erekson E, Murchison RL, Gerjevic KA, Meljen VT, Strohbehn K. Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am J Obstet Gynecol. 2017;217(5):608 e601–17.CrossRefGoogle Scholar
  19. 19.
    Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22(1):3–15.CrossRefGoogle Scholar
  20. 20.
    Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Neurourol Urodyn. 2012;31(4):415–21.CrossRefGoogle Scholar
  21. 21.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefGoogle Scholar
  22. 22.
    Al-Kadri HM, Al-Turki HA, Saleh AM. Short and long-term complications of abdominal and vaginal hysterectomy for benign disease. Saudi Med J. 2002;23(7):806–10.PubMedGoogle Scholar
  23. 23.
    van der Ploeg JM, van der Steen A, Oude Rengerink K, van der Vaart CH, Roovers JP. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121(5):537–47.CrossRefGoogle Scholar
  24. 24.
    Schiavi MC, Savone D, Di Mascio D, Di Tucci C, Perniola G, Zullo MA, et al. Long-term experience of vaginal vault prolapse prevention at hysterectomy time by modified McCall culdoplasty or Shull suspension: clinical, sexual and quality of life assessment after surgical intervention. Eur J Obstet Gynecol Reprod Biol. 2018;223:113–8.CrossRefGoogle Scholar
  25. 25.
    Spelzini F, Frigerio M, Manodoro S, Interdonato ML, Cesana MC, Verri D, et al. Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study. Int Urogynecol J. 2017;28(1):65–71.CrossRefGoogle Scholar
  26. 26.
    Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11–26. e13.CrossRefGoogle Scholar
  27. 27.
    Nam KH, Jeon MJ, Hur HW, Kim SK, Bai SW. Perioperative and long-term complications among obese women undergoing vaginal surgery. Int J Gynaecol Obstet. 2010;108(3):244–6.CrossRefGoogle Scholar
  28. 28.
    Chen CC, Collins SA, Rodgers AK, Paraiso MF, Walters MD, Barber MD. Perioperative complications in obese women vs normal-weight women who undergo vaginal surgery. Am J Obstet Gynecol. 2007;197(1):98 e91–8.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Hanan Alshankiti
    • 1
    • 2
    Email author
  • Sara Houlihan
    • 1
    • 2
  • Magali Robert
    • 1
    • 2
  • Calgary Women’s Pelvic Health Research Group
  1. 1.Foothills Medical CentreUniversity of CalgaryCalgaryCanada
  2. 2.Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryCanada

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