Pelvic organ prolapse surgery following hysterectomy on benign indications
ABSTRACT The objective of the study was to determine the risk for pelvic organ prolapse surgery attributed to hysterectomy on benign indications
In a nationwide longitudinal study, 162,488 women with hysterectomy from 1973 through 2003 were matched to 470,519 population-based control women. Hazard ratios (HR) with 95% confidence interval (CI) were calculated using Cox regression analyses.
In all, 3.2% (n = 5270) of women with hysterectomy had pelvic organ prolapse surgery, compared with 2.0% (n = 9437) in nonhysterectomized controls. Compared with nonhysterectomized controls, the overall HR for prolapse surgery was 1.7 (95% CI, 1.6 to 1.7) with the highest risks observed in women having had a vaginal hysterectomy (HR 3.8; 95% CI, 3.1 to 4.8). Compared with hysterectomized women with no vaginal births, the HR for prolapse surgery was 2.0 (95% CI, 0.9 to 4.1) among women with 1 vaginal childbirth and 11.3 (95 % CI, 6.0. to 21.1) among women with at least 4 vaginal births.
Hysterectomy is associated with an increased risk for subsequent pelvic organ prolapse surgery with multiparous women at particular risk.
SourceAvailable from: Guenter Karl Noé[Show abstract] [Hide abstract]
ABSTRACT: Today, laparoscopic intrafascial hysterectomy and laparoscopic supracervical hysterectomy are well-accepted techniques. With our multimodal concept of laparoscopic hysterectomy for benign indications, preservation of the pelvic floor as well as reconstruction of pelvic floor structures and pre-existing prolapse situations can be achieved. The multimodal concept consists of 3 steps: 1. Intrafascial hysterectomy with preservation of existing structures A. Technique 1: Primary uterine artery ligation B. Technique 2: Classic intrafascial hysterectomy 2. A technique for the stable fixation of the vaginal or cervical stump 3. A new method of pectopexy to correct a pre-existing descensus situation Results and Conclustion: This well-balanced concept can be used by advanced endoscopic gynecologic surgeons as well as by novices in our field.01/2014; 18(1):89-101. DOI:10.4293/108680813X13693422520846
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ABSTRACT: Objectives: The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long-term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse. Methods: PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence Questionnaire—Vaginal Symptoms before and after operation. Results: The average follow-up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively). Conclusion: PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly.Lower urinary tract symptoms 09/2013; 5(3). DOI:10.1111/luts.12004 · 0.54 Impact Factor
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ABSTRACT: Introduction and hypothesis The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to estimate the risk of undergoing POP surgery after hysterectomy. Methods The study was a population-based registry study. Patient data from 154,882 women hysterectomized for benign conditions in the period from 1977 to 2009 were extracted from the Danish National Patient Registry. Patients were followed up from hysterectomy to POP surgery, death/emigration, or end of study period. An estimate of the hazard of undergoing POP surgery following hysterectomy was calculated. Survival analysis was performed using the Kaplan-Meier product limit method. Results The frequency of POP surgery on hysterectomized women was high the first 2 years of the follow-up period with almost 800 women operated yearly. More than one third (n = 2,872) of all women operated for POP were operated less than 5 years after the hysterectomy with a median of 8.6 years. The cumulated incidence of POP surgery after hysterectomy with follow-up of up to 32 years was 12 %; 50 % (n = 5,451) of all POP surgeries were in the posterior compartment. The mean age of women undergoing a first POP surgery after hysterectomy was 60 years. Conclusions POP after hysterectomy occurs as a long-term complication of hysterectomy; 12 % of hysterectomized women were operated for POP. They were operated at younger age than non-hysterectomized women and half the POP operations were performed in the posterior compartment.International Urogynecology Journal 09/2014; 26(4). DOI:10.1007/s00192-014-2490-y · 2.16 Impact Factor