Incidence of pelvic floor repair after hysterectomy: A population-based cohort study

Abstract

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

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

“…This is supported by data from Blandon et al, 131 who reported that, in comparison with women without prolapse, women who had a hysterectomy for prolapse were at increased risk for subsequent pelvic floor repair.…”

Rectocele and intussusception: is there any coherence in symptoms or additional pelvic floor disorders?

“…Interestingly, a rectocele appears in combination with an intussusception in about 16% of patients after a hysterectomy and is a consequence of a weakened pelvic floor [11]. However, the effect of a hysterectomy on POP has been debated, with no consensus to date [12][13][14].…”

Concomitant apical suspensory procedures in women with anterior vaginal wall prolapse in the United States in 2011

“…This is likely because the apical compartment is exposed at the time of surgery, improving access for apical suspension during closure of the vaginal cuff. In addition, published evidence has demonstrated the importance of concomitant apical suspension at the time of hysterectomy as treatment for uterovaginal prolapse [8,18,19]. The American Congress of Obstetricians and Gynecologists has incorporated this evidence into published guidelines supporting routine apical suspension at the time of hysterectomy for women with pelvic organ prolapse [20].…”