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

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Abstract

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.

Methods

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

Results

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).

Conclusions

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

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Funding

This study was unfunded.

Author information

Authors and Affiliations

  1. Sydney Medical School Nepean, University of Sydney, Sydney, Australia

    Talia Friedman & Hans Peter Dietz

  2. Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

    Talia Friedman

  3. The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney, Australia

    Guy D. Eslick

Authors
  1. Talia Friedman
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  2. Guy D. Eslick
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  3. Hans Peter Dietz
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Corresponding author

Correspondence to Talia Friedman.

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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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Friedman, T., Eslick, G.D. & Dietz, H.P. Risk factors for prolapse recurrence: systematic review and meta-analysis. Int Urogynecol J 29, 13–21 (2018). https://doi.org/10.1007/s00192-017-3475-4

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