Incidence of pelvic organ prolapse repair subsequent to hysterectomy: a comparison between radical hysterectomy and total abdominal hysterectomy

Lykke, Rune; Blaakær, Jan; Ottesen, Bent; Gimbel, Helga

doi:10.1007/s00192-016-3173-7

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…This procedure is thought to help prevent prolapse, especially apical prolapse [16,17]. However, when Lykke et al looked at POP rates after radical hysterectomy versus simple total abdominal hysterectomy, they found more POP repairs took place following simple hysterectomies [18]. Considering that more supporting ligaments are removed in radical hysterectomies, these data do not agree with the idea that disrupting these supports leads to more POP.…”

Section: Discussionmentioning

confidence: 99%

Pelvic organ prolapse surgery after different hysterectomy methods: a population-based cohort study

Klimczak

Kilic

Ünlü

et al. 2019

Clin. Exp. Obstet. Gynecol.

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The US Census Bureau projects that the number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050 [1]. Considering yearly surgical costs in the US have been consistently greater than one billion USD since 1997, it is safe to project that the surgical healthcare expense for pelvic organ prolapse (POP) will be exponentially increased by 2050 [2]. Hysterectomy, among other factors, has been associated with an increased risk for subsequent POP [3][4][5][6][7]. Altman et al. studied the risk for POP surgery attributed to hysterectomy until the year 2003 [4]. However, since 2003, rapidly developing technology has created a shift towards laparoscopic and robotic techniques for uterine removal as opposed to the open laparotomy method [8, 9].Although the benefits of laparoscopic/robotic modalities are well known, their association with future risk for prolapse, compared to vaginal or open abdominal hysterectomy, remains unclear. The present authors utilized a large-scale patient population to examine the association of future prolapse repair with different types of hysterectomy.The aim of this study was to estimate the incidence of POP surgery after abdominal hysterectomies compared to laparoscopic/robotic-assisted, vaginal, and supracervical hysterectomies for benign cases in the US. Materials and MethodsThe present authors conducted a retrospective cohort study using health insurance claims from the Clinformatics Data Mart (CDM) Database. This de-identified database contains insurance claims for medical services and drug prescriptions for over 56 million enrollees in the US. This study was determined to be exempt by the institutional review board of the University of Texas Medical Branch at Galveston.The study cohort consisted of women aged 18-64 who received hysterectomies between January 2005 and September 2014 (Table 1) with any of the following modalities: robotic or laparoscopic, supracervical, open abdominal, or vaginal procedures (Table 2). The authors included women who had continuous insurance enrollment 12 months before and three months after the hysterectomies (Figure 1). The authors excluded women with prolapse procedure or diagnosis (Table 3) in the 12 months prior to hysterectomy because they are more likely to have a prolapse compared to those without history regardless of the hysterectomy modality. The authors also excluded any concomitant prolapse procedures or diagnoses, as well as prolapse procedures or diagnoses in the immediate three months following hysterectomy (Figure 1). That is, the authors excluded POP that was not identified

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Section: Discussionmentioning

confidence: 99%

Pelvic organ prolapse surgery after different hysterectomy methods: a population-based cohort study

Klimczak

Kilic

Ünlü

et al. 2019

Clin. Exp. Obstet. Gynecol.

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“…Our observation is supported by that of Lykke et al, who analyzed POP repair subsequent to hysterectomy in 5279 women with radical hysterectomy and 149,920 women with total abdominal hysterectomy. They found the distribution of POP operations in relation to compartments to be predominant for the posterior one (50%) compared to the anterior (40%) and the apical compartments (10%) [ 22 ]. This is coherent with the anatomy of pelvic support described by Perucchini et al [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

The distribution of pelvic organ support defects in women undergoing pelvic organ prolapse surgery and compartment specific risk factors

2021

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Introduction and hypothesis The objective of our study was to describe the distribution of pelvic organ prolapse (POP) in a population of women undergoing POP reconstructive surgery and to identify compartment-specific risk factors. Methods We conducted a retrospective observational study in a cohort of 326 women who underwent POP repair and had a standardized preoperative POP assessment using the Baden-Walker classification. The distribution of POP grade was described for each vaginal compartment. The association between the involvement of each specific compartment and predictors was evaluated with a logistic regression model. Results The frequency of significant POP (grade ≥ 2) was 79% in the anterior compartment, 49% in the middle/apical compartment and 31% in the posterior compartment. Combined significant anterior and apical defects were present in 25% of women. Increasing age was a significant risk factor for apical defect (between 60 and 70 years OR = 2.4, 95% CI 1.2–4.6; > 70 years OR = 3.4, 95% CI 1.7–6.6). Previous hysterectomy (OR = 2.2, 95% CI 1.0–4.6) was a significant risk factor for posterior defect. Conclusions In a population undergoing POP surgery, anterior compartment involvement is the most common and serious defect and can often be associated with an apical defect, especially in older women. In case of previous hysterectomy, the posterior compartment may be weakened. These findings may help surgeons to select the appropriate POP reconstructive surgery, which often should address both anterior and apical defects.

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“…Indeed, in a recent Danish National Patient Registry study of over 150,000 women, those who underwent total abdominal simple hysterectomy were significantly more likely to undergo subsequent operation for pelvic organ prolapse than women who underwent total abdominal radical hysterectomy, suggesting that women with elective indications for hysterectomy may be different from those without. 7 …”

Section: Cum Hoc Ergo Propter Hoc? (With This Therefore Because Of mentioning

confidence: 99%

Hysterectomy: More Harm Than Good or Innocent Bystander?

Rice¹,

Brown²

2017

Diseases of the Colon &Amp; Rectum

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Incidence of pelvic organ prolapse repair subsequent to hysterectomy: a comparison between radical hysterectomy and total abdominal hysterectomy

Abstract: This study found a significantly lower incidence of subsequent POP operations among women who undergo radical hysterectomy than total abdominal hysterectomy.

Cited by 5 publications

References 15 publications

Pelvic organ prolapse surgery after different hysterectomy methods: a population-based cohort study

Pelvic organ prolapse surgery after different hysterectomy methods: a population-based cohort study

The distribution of pelvic organ support defects in women undergoing pelvic organ prolapse surgery and compartment specific risk factors

Hysterectomy: More Harm Than Good or Innocent Bystander?

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