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Factors involved in prolapse recurrence one year after anterior vaginal repair

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Abstract

Introduction and hypothesis

The aim of this study was to identify which factors are associated with anatomic and symptomatic prolapse recurrence in the anterior compartment 1 year after traditional anterior vaginal repair. Our study hypothesis was that major defects in pelvic floor support structures before surgery are associated with higher recurrence rates.

Methods

This was a prospective multicenter study including women with symptomatic anterior compartment prolapse who underwent primary vaginal surgery. Prolapse examination was performed using the Pelvic Organ Prolapse Quantification (POP-Q) system, prolapse symptoms were described using the Pelvic Floor Distress Inventory short form (PFDI-20), and levator ani avulsion and hiatal area were identified by translabial 3D ultrasonography.

Results

During the inclusion period, 455 patients were recruited and 442 (97.1%) attended the 1-year follow-up. In three cases, ultrasound data were not available, and the remaining 439 formed the study group. Anatomic and symptomatic recurrence rates were 45.1% and 6.8%, respectively. Levator avulsion increased the risk of anatomic (OR: 1.96) and symptomatic (OR: 2.60) recurrence; abnormal distensibility of the levator hiatal area increased the risk of anatomic (OR: 2.51) and symptomatic (OR: 2.43) recurrence; advanced prolapse increased the risk of anatomic recurrence: POP-Q stage 3 (OR: 2.34) and POP-Q stage 4 (OR: 5.47).

Conclusions

Major defects in pelvic floor support structures before surgery are associated with higher recurrence rates 1 year after native tissue vaginal repair. Advanced stage of prolapse increases the risk of anatomic recurrence, while levator avulsion and abnormal distensibility of the levator hiatus area increase the risk of both anatomic and symptomatic recurrence.

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References

  1. Hendrix S, 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;186:1160–6.

    Article  Google Scholar 

  2. 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.

    Article  CAS  Google Scholar 

  3. Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116:1096–100.

    Article  Google Scholar 

  4. Wu JM, Matthews CA, Conover MM, Pate V, Funk MJ. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.

    Article  Google Scholar 

  5. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11:CD004014.

    PubMed  Google Scholar 

  6. Vergelt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26:1559–73.

    Article  Google Scholar 

  7. Friedman T, Eslick GD, Dietz HP. Risk factors for prolapse recurrence: systematic review and meta-analysis: systematic review and meta-analysis. Int Urogynecol J. 2019;29(1):13–21.

    Article  Google Scholar 

  8. Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115:979–84.

    Article  CAS  Google Scholar 

  9. Young N, Atan IK, Rojas RG, Dietz HP. Obesity: how much does it matter for female pelvic organ prolapse? Int Urogynecol J. 2008;29(8):1129–34.

    Article  Google Scholar 

  10. Dietz HP, Chantarasorn V, Shek KL. Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol. 2010;36:76–80.

    Article  CAS  Google Scholar 

  11. 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. 2007;18:1317–24.

    Article  CAS  Google Scholar 

  12. Miedel A, Tegerstedt G, Mörlin B, Hammarström M. A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1593–601.

    Article  Google Scholar 

  13. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369:1027–38.

    Article  Google Scholar 

  14. Bump RC, Mattiason A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7.

    Article  CAS  Google Scholar 

  15. Sánchez-Sánchez B, Torres-Lacomba M, Yuste-Sánchez MJ, Navarro-Brazález B, Pacheco-da-Costa S, Gutiérrez-Ortega C, et al. Cultural adaptation and validation of the pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7) Spanish versions. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):281–5.

    Article  Google Scholar 

  16. Dietz H, Shek K, Clarke B. Biometry of the pubovisceral and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25:580–5.

    Article  CAS  Google Scholar 

  17. Dietz HP, Bernardo MJ, Kirby A, Shek KL. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22:699–704.

    Article  Google Scholar 

  18. Dietz HP, Shek C, De Leon J, Steensma AB. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31:676–80.

    Article  CAS  Google Scholar 

  19. Rodrigo N, Wong V, Shek KL, Martin A, Dietz HP. The use of 3-dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery. Aust N Z J Obstet Gynaecol. 2014;54(3):206–11.

    Article  Google Scholar 

  20. Weemhoff M, Vergeldt TF, Notten KJ, Serrooyen J, Kampschoer P, Roumen F. Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J. 2012;23(1):65–71.

    Article  Google Scholar 

  21. Vergeldt TF, Notten KJ, Weemhoff M, van Kuijk SM, Mulder FE, Beets-Tan RG, et al. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study. BJOG. 2015;122(8):1130–7.

    Article  CAS  Google Scholar 

  22. Barber MD, Brubaker L, Nygaard I, Wheeler TL II, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114:600–9.

    Article  Google Scholar 

  23. Chmielewski L, Walters MD, Weber AM, Barber MD. Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol. 2011;205:69.e1–8.

    Article  Google Scholar 

  24. Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol. 2001;185:1299–306.

    Article  CAS  Google Scholar 

  25. Dietz HP, Hankins KJ, Wong V. The natural history of cystocele recurrence. Int Urogynecol J. 2014;25:1053–7.

    Article  CAS  Google Scholar 

  26. Lowestein E, Moller LA, Laigaard J, Gimbel H. Reoperation for pelvic organ prolapse: a Danish cohort study with 15-20 years' follow-up. Int Urogynecol J. 2018;29:119–24.

    Article  Google Scholar 

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Authors and Affiliations

  1. Servicio de Obstetricia y Ginecología, Hospital Universitario Donostia, San Sebastián, Spain

    Irene Diez-Itza, Marisa Avila, Sabiñe Uranga, Maria Belar & Arantza Lekuona

  2. Departamento de Especialidades Médico-Quirúrgicas, Universidad del País Vasco / Euskal Herriko Unibertsitatea, Leioa, Spain

    Irene Diez-Itza, Sabiñe Uranga & Arantza Lekuona

  3. IIS Biodonostia, San Sebastián, Spain

    Irene Diez-Itza, Maria Belar & Arantza Lekuona

  4. Servicio de Obstetricia y Ginecología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain

    Alicia Martin

Authors
  1. Irene Diez-Itza
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  2. Marisa Avila
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  3. Sabiñe Uranga
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  4. Maria Belar
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  5. Arantza Lekuona
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  6. Alicia Martin
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Contributions

• I Diez-Itza: Project development, data collection, data analysis, manuscript writing.

• M Avila: Data collection.

• S Uranga: Data collection.

• M Belar: Data collection.

• A Lekuona: Project development.

• A Martin: Project development, data collection.

Corresponding author

Correspondence to Irene Diez-Itza.

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Diez-Itza, I., Avila, M., Uranga, S. et al. Factors involved in prolapse recurrence one year after anterior vaginal repair. Int Urogynecol J 31, 2027–2034 (2020). https://doi.org/10.1007/s00192-020-04468-1

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  • DOI: https://doi.org/10.1007/s00192-020-04468-1

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