OBJECTIVE-The objective of the study was to assess the incidence of and risk factors for pelvic floor repair (PFR) procedures after hysterectomy. RESULTS-The cumulative incidence of PFR after hysterectomy was 5.1% by 30 years. This risk was not influenced by age at hysterectomy or calendar period. Future PFR was more frequently required in women who had prolapse, whether they underwent a hysterectomy alone (eg, vaginal [hazard ratio (HR) 4.3; 95% confidence interval (CI) 2.5 to 7.3], abdominal [HR 3.9; 95% CI 1.9 to 8.0]) or a hysterectomy and PFR (ie, vaginal [HR 1.9; 95% CI 1.3 to 2.7] or abdominal [HR 2.9; 95% CI 1.5 to 5.5]). STUDY DESIGN-UsingCONCLUSION-Compared with women without prolapse, women who had a hysterectomy for prolapse were at increased risk for subsequent PFR. Keywords epidemiology; posthysterectomy; prolapse; risk factors Pelvic organ prolapse is common and a major indication for gynecologic surgery in the United States. It is estimated that United States women have an 11% lifetime risk of surgery for prolapse or incontinence. 1 Indeed, approximately 200,000 operations for prolapse are performed annually in this country, with a cost exceeding $1 billion. 2,3 Consequently, it is important to identify the factors that contribute to this problem to improve on both its prevention and treatment. Several risk factors have been proposed to initiate, aggravate, or contribute to decompensation in pelvic organ prolapse. 4 These include increasing age, higher gravidity and parity, obesity, conditions associated with increased intraabdominal pressure (eg, constipation), and prior hysterectomy. 1,5,6 The latter is particularly important because hysterectomy is second only to cesarean section as the most frequently performed major operation among women in this country 7 and because it has been estimated that up to one-third of operations for pelvic organ prolapse are repeat procedures. 1

and analysis of variance were used to compare the results. RESULTSIn all, 95 patients had 105 test procedures; 30 peripheral nerve evaluation (PNE) and 75 staged tined leads. Response rates were lower in the PNE than in the tined lead (40% vs 67%, P = 0.01). The indication for SNS was associated with the response rate, with urinary retention having the highest response (71%, P = 0.01). For the 55 implanted devices, there were 18 revisions (33%) and eight explants (15%). The main reasons for revision or explants were loss of efficacy (16/26) and pain at the implant site (six of 26). The median (range) time to intervention after implantation was 17 (1.2-75.0) months, and this was significantly associated with the indication. Revisions due to pain at the implant site were within the first year, and reoperations due to loss of efficacy after 1-2 years, whereas battery replacement was required on average 4 years after initial implantation. CONCLUSIONSThis study confirms the higher response rates of the tined-lead staged technique over PNE. Unobstructive urinary retention had the highest response rates. The reason for revision appeared to be largely predicted by the length of time since implantation. KEYWORDSInterStim, urinary incontinence, urinary retention, interstitial cystitis, overactive bladder, adverse effects Study Type -Therapy (outcomes research) Level of Evidence 2c

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