Risk factors for prolapse recurrence after vaginal repair

Whiteside, James L.; Weber, Anne M.; Meyn, Leslie A.; Walters, Mark D.

doi:10.1016/j.ajog.2004.06.109

Cited by 289 publications

(185 citation statements)

References 10 publications

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“…Prolapsed patients of a younger age were suspected of having a more pronounced tendency to present pathophysiology such as inferior tissue quality, and greater nerve, muscle, and fascial injury; but from another point of view, older patients were restricted from activity due to underlying medical problems [14]. The advanced preoperative stage (POP-Q stage III or IV) was another risk factor, as seen in the study of Whiteside et al [9]. Vakili et al [10] reported that diminished levator ani and widened genital hiatus were related to the recurrent prolapse through a median 5-month follow-up in 451 patients who received pelvic reconstructive surgery.…”

Section: Discussionmentioning

confidence: 83%

“…Data arise from a few studies with few identified risk factors [7]. According to the previous studies, younger age, preoperative advanced stage, traumatic delivery, urinary incontinence, and previous pelvic reconstructive surgery are suggested as the risk factors for recurrence [8][9][10][11]. Whiteside et al [9] studied 176 patients out of 389 who were observed for a year after vaginal reconstructive surgery to find that younger age (<60 years) was an important factor.…”

Section: Discussionmentioning

confidence: 99%

“…According to the previous studies, younger age, preoperative advanced stage, traumatic delivery, urinary incontinence, and previous pelvic reconstructive surgery are suggested as the risk factors for recurrence [8][9][10][11]. Whiteside et al [9] studied 176 patients out of 389 who were observed for a year after vaginal reconstructive surgery to find that younger age (<60 years) was an important factor. A similar result was presented by Nieminen et al [11], who evaluated the risk factors of recurrence in patients who received sacrospinous ligament fixation.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Jung

Kim

Moon

et al. 2012

Korean J Obstet Gynecol

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Pelvic organ prolapse (POP) is a bulge or protrusion into or through the vagina of pelvic organs and associated vaginal segments [1]. With the aging population, POP is an increasingly common condition seen in women with a lifetime prevalence of 30% to 50% [1,2]. Symptomatic urogenital prolapse has been shown to have significant negative impacts such as those relating to the lower urinary tract, fecal incontinence, back pain, pelvic pain, defecatory problems, and dyspareunia. Management options for women with symptomatic POP include observation, pelvic floor muscle training, mechanical support (pessaries), and surgery. A patient's perception of discomfort from POP and subsequent treatment will vary in relation to the stage of the POP and her ethnicity. Currently, many surgical approaches have been introduced to correct POP. The life time risk of undergoing surgery was estimated to be between 11% and 19%. However, none of these techniques is without risks for complications [2][3][4]. The prevalence of reopera-ORIGINAL ARTICLE Korean J Obstet Gynecol 2012;55(8) ObjectiveThe aim of this study was to report subjective and objective outcomes and to compare complication and recurrence rate in patients undergoing surgery for International Continence Society (ICS) stage 4 prolapse compared to ICS stage 2 or 3 prolapse. MethodsWe retrospectively reviewed the records of all patients having had surgical treatment for ICS Pelvic Organ Prolapse Quantification (POP-Q) stage 2-4 prolapse between January 2007 and December 2010 at the Yonsei University Severance Hospital. Only patients with ICS POP-Q stage 2-4 prolpase undergoing obliterative procedures or anti-incontinence surgery only were excluded. ResultsThree hundred ninety nine patients met inclusion criteria, including 23 with stage 2, 239 with stage 3 and 137 with stage 4 prolapse. The postoperative recurrence rate of preoperative stage IV was 2.4 times higher than that of stage III. There was a significantly higher incidence rates of perioperative and long-term complications, compared to women with other stage prolapse. The mean operative time was significantly greater in the stage 4 group compared to the stage 2, 3 group. ConclusionThe overall perioperative complication and recurrence rates in women undergoing surgery for pelvic organ prolapse are low. Women undergoing surgery for ICS POP-Q stage 4 prolapse were found to have a significantly greater blood loss and higher incidence rates of perioperative complications and recurrence, compared with women of other stage.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Jung

Kim

Moon

et al. 2012

Korean J Obstet Gynecol

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“…A number of risk factors for prolapse recurrence after pelvic reconstructive surgery have been documented in the literature, including younger age, 44 , 45 a family history of prolapse, 46 preoperative prolapse grading, 44 – 47 poor pelvic floor muscle contractility, 48 previous hysterectomy, body mass index, 45 previous prolapse surgery, a larger genital hiatus 48 and sacrospinous fixation 46 . More recently levator avulsion 3 , 12 , 46 , 49 , 50 and hiatal ballooning, 43 i.e.…”

Section: Methodsmentioning

confidence: 99%

“…In a study on prolapse recurrence, 43 which included 334 patients at a mean follow‐up of 2.5 years after cystocele repair, levator avulsion was associated with an odds ratio of 2.95 for recurrence, and hiatal area on Valsalva conveyed an additional 7% per cm 2 for risk of recurrence (Figure 6 and 7). This implies that the likelihood of recurrence may vary from 10 to 90% in a patient with a given degree of cystocele, depending on the integrity of the levator ani muscle and hiatal area on Valsalva 44 (Figure 8). Both factors in combination may effectively identify patients in whom conventional surgery is likely to fail, and this effect seems to explain most other described predictors of recurrence such as younger age, enlarged genital hiatus and poor levator contractility.…”

Section: Methodsmentioning

confidence: 99%

Imaging of slings and meshes

Shek

Dietz

2014

Australas J Ultrason Med

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The popularity of imaging in pelvic floor medicine continues to increase. Among the various modalities, ultrasound is superior as it is cheap, safe, easily accesible and simple, resulting in high patient compliance. It is the only technique that allows imaging of modern wide‐weave polypropylene sling or mesh implants, and imaging of such implants is commonly required due to the popularity of surgical techniques that involve the placement of slings and meshes. This review article will discuss the role of translabial ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse.

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Long‐term outcomes and five‐year recurrence‐free survival curves after native‐tissue prolapse repair

Deo

Bernasconi

Cola

et al. 2019

Intl J Gynecology & Obste

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Objective: To evaluate the long-term objective and subjective outcomes to build recurrence-free survival curves after mesh-free uterosacral ligament suspension and to evaluate the long-term impact of prognostic factors on outcome measures. Methods:A retrospective study analyzed 5-year follow-up after repair of primary prolapse through high uterosacral ligament suspension. Bulging symptoms and postoperative prolapse stage II or above were considered subjective and objective recurrences, respectively. The cumulative proportion of relapse-free patients in time was analyzed by Kaplan-Meier curves.Results: A total of 353 women were analyzed. Five-year recurrence rates were 15.0% for objective recurrence, 13.0% for subjective recurrence, and 4.0% for the combined objective and subjective recurrences. Premenopausal status was shown to be a risk factor for anatomic (P=0.022), symptomatic (P=0.001), and combined (P=0.047) recurrence. Conversely, anterior repair was shown to be a protective factor for symptomatic (P=0.012) and combined (P=0.002) recurrence. Most of the recurrences occurred within 2 years after surgery. Conclusion:Long-term outcomes after high uterosacral ligament suspension were satisfactory. Premenopausal status and lack of anterior repair represented risk factors for recurrence in the long term. K E Y W O R D SLong-term follow-up; Native-tissue repair; Prolapse surgery; Recurrence; Risk factors; Uterosacral ligament suspension

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Risk factors for prolapse recurrence after vaginal repair

Cited by 289 publications

References 10 publications

Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Imaging of slings and meshes

Long‐term outcomes and five‐year recurrence‐free survival curves after native‐tissue prolapse repair

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