What is the risk of pelvic organ prolapse recurrence after vaginal hysterectomy with colporrhaphy?

Česká verze

Authors: M. Nováčková; Z. Pastor ; Tomáš Brtnický ; R. Chmel
Authors place of work: Gynekologicko-porodnická klinika 2. LF UK a FN Motol, Praha, přednosta MUDr. R. Chmel, Ph. D., MHA.
Published in the journal: Ceska Gynekol 2017; 82(5): 383-389

Summary

Objective:
To determine the risk of prolapse recurrence in patients after vaginal hysterectomy with colporrhaphy.

Design:
Retrospective clinical study.

Setting:
Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague.

Methods:
The trial involved 220 women who underwent vaginal hysterectomy with anterior and posterior kolporrhaphy at our department for uterine prolapse at least grade 2. It was the first vaginal surgery in all of the patients. Subjective feeling of pressure in the vagina and/or palpable mass in the vagina or in front of the vaginal entrance and/or objective finding decline of the vaginal walls or fundus at lest the second degree or repeated surgery for prolapse were considered as a prolapse recurrence.

Results:
The mean age at the time of vaginal hysterectomy was 66.7 years (range 37–88). Only 11 patients were premenopausal (5%), the others were postmenopausal, a mean time of posmenopause was 16.9 years. The average parity rate of the study group was 2.1. The average duration of the surgery was 68 minutes. Postoperative urinary retention was observed in one patient (0.45%). 156 women were enrolled in the study. The average length of follow-up was 47 months (minimum 24 months). Recurrence of prolapse based on subjective assessment occured in 24 patients (15.4 %) with pressure and resistance in the vaginal introitus. According to objective criteria, the recurrence of prolapse was diagnosed in 33 (21.2%) patients, of which 16 had prolapse of the anterior vaginal wall, three of the posterior vaginal wall (two rectocoele, one rectoenterocoele), eight combination prolapse of anterior and posterior vaginal wall and vaginal vault prolapse was diagnosed in six women.

Eight patients (5. 1%) underwent surgery because of prolapse recurrence. The mean interval from primary surgery to the time of reoperation was 24.4 months (range 6–62).

Conclusion:
Patients have to be preoperatively informed about the risk of the prolapse recurrence with the recommendation of appropriate preventive arrangements.

Keywords:
vaginal hysterectomy, recurrence, colporrhaphy, vaginal vault prolapse, pelvic organ prolapse, POP

Zdroje

1. Abdool, Z., Dietz, HP., Lindeque, BG. Prolapse symptoms are associated with abnormal functional anatomy of the pelvic floor. Int Urogynecol J, 2017, doi: 10. 1007/s00192-017-3280-0.

2. Alkatout, I., Mettler, L., Peters, G., et al. Laparoscopic hysterectomy and prolapse: a multiprocedural concept. JSLS, 2014, 18(1), p. 89–101.

3. Altman, D., Falconer, C., Cnattingius, S., Granath, F. Pelvic organ prolapse surgery following hysterectomy on benign indications. Am J Obstet Gynecol, 2008, 198(572), p. 1–6.

4. Barber, MD., Brubaker, L., Nygaard, I., et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol, 2009, 114(3), p. 600–609.

5. Blandon, RE., Bharucha, AE., Melton, LJ., et al. Risk factors for pelvic floor repair after hysterectomy. Obstet Gynecol, 2009, 113(3), p. 601–608.

6. Brummer, THI., Jalkanen, J., Fraser, J., et al. FINHYST 2006 – national prospective 1-year survey of 5279 hysterectomies. Hum Reprod, 2009, 24(10), p. 2515–2522.

7. Bump, RC., Mattiasson, A., Bø, K., et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 1996, 175(1), p. 10–17.

8. Dällenbach, P., Kaelin-Gambirasio, I., Jacob, S., et al. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19, p. 1623–1629.

9. Detollenaere, RJ., den Boon, J., Stekelenburg, J., et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ, 2015, 351, p. 1–9.

10. Dietz, HP. Pelvic organ prolapse – a review. Aust Fam Physician, 2015, 44(7), p. 446–452.

11. Dietz, V., Schraffordt Koops, SE., van der Vaart, CH. Vaginal surgery for uterine descent; which options do we have? A review of the literature. Int Urogynecol J Pelvic Floor Dysfunct, 2009, 20, p. 349–356.

12. Durnea, CM., Khashan, AS., Kenny, LC. Prevalency, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women. Int Urogynecol J, 2014, 25(11), p. 1463–1470.

13. Ewies, AA., Al-Azzawi, F., Thompson, J. Changes in extracellular matrix proteins in the cardinal ligaments of post-menopausal women with or without prolapse: a computerized immunohistomorphometric analysis. Hum Reprod, 2003, 18(10), p. 2189–2195.

14. Forsgren, C., Lundholm, C., Johansson, ALV., et el. Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery. Int Urogynecol J, 2012, 23, p. 43–48.

15. Ghezzi, F., Cromi, A., Uccella, S. Immediate Foley removal after laparoscopic and vaginal hysterectomy: determinants of postoperative urinary retention. J Minim Invasive Gynecol, 2007, 14(6), p. 706–711.

16. Chong, C., Kim, HS., Suh, DH., Jee, BC. Risk factors for urinary retention after vaginal hysterectomy for pelvic organ prolapse. Obstet Gynecol Sci, 2016, 59(2), p. 137–143.

17. Jelovsek, JE., Maher, C., Barber, MD. Pelvic organ prolapse. Lancet, 2007, 24(369), p. 1027–1038.

18. Kudela, M., Ondrová, D., Hejtmánek, P. Etiopatogeneze prolapsu pochvy po hysterektomii. Čes Gynek, 2006, 71, 4, s. 329–332.

19. Liang, CC., Lee, CL., Chang, TC. Postoperative urinary outcomes in catheterized and non-catheterized patients undergoing laparoscopic-assisted vaginal hysterectomy – a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct, 2009, 20(3), p. 295–300.

20. Moen, MD., Richter, HE. Vaginal hysterectomy: past, present, and future. Int Urogynecol J, 2014, 25(9), p. 1161–1165.

21. Olsen, AL., Smith, VJ., Bergstrom, JO. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol, 1997, 89(4), p. 501–506.

22. Pattillo Garnham, A., Guzmán Rojas, R., Shek, KL., Dietz, HP. Predicting levator avulsion from ICS POP-Q findings. Int Urogynecol J, 2017, 28(6), p. 907–911.

23. Rappa, C., Saccone, G. Recurrence of vaginal prolapse after total vaginal hysterectomy with concurrent vaginal uterosacral ligament suspension: comparison between normal-weight and overweight women. Am J Obstet Gynecol, 2016, 215(5), p. 601–604.

24. Rortveit, G., Brown, JS., Thom, DH., et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in population-based, racially diverse cohort. Obstet Gynecol, 2007, 109(6), p. 1396–1403.

25. Švabík, K., Martan, M., Mašata, J. Prolaps a avulzní poranění levatoru. Čes Gynek, 2012, 77, 4, s. 304–307.

26. Tolstrup, CK., Lose, G., Klarskov, N. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review. Int Urogynecol J, 2017, 28(1), p. 33–40.

27. Töz, E., Ozcan, A., Apaydin, N., et al. Outcomes of vaginal hysterectomy and constricting colporrhaphy with concurrent levator myorrhaphy and high perineorrhaphy in women older than 75 years of age. Clin Interv Aging, 2015, 10, p. 1009–1015.

28. Vergeldt, TFM., Weemhoff, M., IntHout, J., Kluivers, K. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J, 2015, 26, p. 1559–1573.

29. Wu, J., Matthews, CA., Conover, MM., et al. Lifetime risk of stress incontinence or pelvic organ prolapse surgery. Obstet Gynecol, 2014,123, p. 1201–1206.