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

Abstract

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.

Laparoscopic Lateral Suspension (LLS) for the Treatment of Apical Prolapse: A New Gold Standard?

“…Knowing the distribution of defects can allow us to better adapt our repair techniques. We have shown in a series of 326 patients representing of a cohort of 1,811 women consulting for surgical correction of genital prolapse over a period of 20 years, that the anterior compartment is most frequently affected and often in association with the middle compartment ( 48 ). In this study we also showed that a previous hysterectomy increased the risk of developing posterior compartment prolapse.…”

“…However, an increasing number of women prefer uterine preservation as it represents a symbol of femininity ( 12 , 13 ). Moreover, hysterectomy is probably an unnecessary act during POP surgery, and may increase the risk of posterior compartment prolapse ( 48 ). Recent studies also show a benefit of uterine preservation by reducing operating time and blood loss without affecting outcome ( 18 , 51 ).…”

Pelvic organ movements in asymptomatic nulliparous and symptomatic premenopausal women with pelvic organ prolapse in dynamic MRI: a feasibility study comparing midsagittal single-slice with multi-slice sequences

“…Contemporary management of pelvic floor disorders involves not only the quantification of POP through measurement of organ points using reference lines but also more tailored and defect-specific treatment approaches that require imaging to deliver more detailed information on structural defects of the pelvic floor [ 27 ]. This customized treatment approach requires an improved understanding of the pathogenesis of POP through a sophisticated assessment of pelvic floor support structures.…”