A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse

Abstract

The objective of this study was to evaluate anatomic, functional, short- and long-term outcome of vaginal surgery for pelvic organ prolapse. This was a prospective observational study of 185 consecutive women planned for vaginal prolapse reconstructive surgery. Stage of prolapse, urinary incontinence (UI), bowel and mechanical symptoms were assessed preoperatively and at 1, 3 and 5 years postoperatively. The mean follow-up time was 53 months. The anatomic recurrence rate was 41.1% but less than half of them were symptomatic. Anterior compartment was most prone for recurrence and the majority of the recurrences took place within the first year. UI remained at the same level at 1-year follow-up. De novo urge occurred in 22.6% and de novo stress incontinence in 6.0%. An improvement was seen in difficulty in emptying bowel 1 year after surgery (54%). Patients were primarily cured from mechanical symptoms. Re-operation rate was 9.7%; if additional operation for incontinence was included, it was13.5%.

The great mesh debate

“…the one that is most likely to recur anatomically) is analysed separately, the re-operation rate is only 4.6% [13]. This has been seen in other studies with re-operation rates for the anterior compartment of between 5% and 10% at intervals between 1 and 5 years after a primary "traditional" procedure [14][15][16][17]. While these re-operation rates are not synonymous with failure, nonetheless, one would imagine that if after "failed" primary surgery the symptoms were bothersome then patients would seek further treatment, whether that be with vaginal pessaries or surgery.…”

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

“…[1][2][3] Anatomical POP recurrence occurs in 40% of women in the operated compartment, with a re-operation rate of 9.7% due to symptomatic recurrence. 4 The main contributor for POP is vaginal delivery with damage to the levator ani muscle (LAM). 5,6 A recent review has shown that this damage, diagnosed on transperineal ultrasound (TPUS) a few months following childbirth, occurs in 13-36% of women.…”

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse

“…On further analysis of the same compartment recurrence (i.e., repeat anterior repair), the reoperation rate was significantly lower, at 4.6% [12]. More recently, several investigators looked specifically at the issue of site-specific recurrence, with reoperation rates ranging from 2.8% to 9.7% [13][14][15]. A recent Cochrane review [16] looking at vault suspension suggested that reoperation rates after POP surgery, which includes suspension of the vaginal vault/apex, are 1.3% to 3.9% at 17 to 32 months respectively, depending upon the type of vault suspension.…”