96: Pelvic organ prolapse recurrence in young women undergoing vaginal and abdominal colpopexy for the management of apical prolapse

Abstract

To compare the incidence of pelvic organ prolapse (POP) recurrence between vaginal and abdominal colpopexy in women <49 years and to describe postoperative satisfaction and pelvic floor symptoms. This is a retrospective cohort study with a cross-sectional component of women aged 18 to 49 years who underwent primary POP surgery from January 2003 to September 2013. Patients were identified by CPT codes for vaginal and abdominal (open and minimally invasive) colpopexy and were included if they underwent apical prolapse surgery for either post-hysterectomy POP or uterovaginal POP with concurrent hysterectomy. The medical record was queried for perioperative data. POP recurrence was defined as vaginal bulge symptoms, retreatment of POP (pessary or surgery) and a composite of the two. Informed consent was obtained and surveys with validated questionnaires (PFDI-20, ISI, PISQ-IR, PGI-I) were used to assess pelvic floor symptoms, patient satisfaction and improvement. Three hundred thirty-three women met criteria. Mean age and BMI were 43 (+5.3) years and 27.9 (+5.8) kg/m2, respectively. The majority of women had a preoperative POP-Q stage of 2 (50.2%) or 3 (47.1%). A total of 29.1% (97) patients had an abdominal colpopexy and 70.9% (236) had a vaginal colpopexy. Patients who underwent abdominal colpopexy were more likely to have had a prior hysterectomy (20.6% vs 4.2%, p<.001) while the vaginal group was more likely to undergo concurrent hysterectomy and anterior repair (94.1% vs 78.4%, p<.001 and 66.5% vs 10.3%, p<.001, respectively). The composite recurrence rate was 32.0% (31) in the abdominal group and 24.2% (57) in the vaginal group (p=.15), with a retreatment rate of 10.3% (10) in the abdominal group and 5.9% (14) in the vaginal group (p=.16). The survey response rate was 45% (149) with a median response time of 2880 (1146-5540) days. The majority of patients (80.5%) reported prolapse improvement, which did not differ by colpopexy approach. However, more women in the abdominal group reported satisfaction with their surgery (100% vs 89.8%, p=.02). 26.8% (40) of women complained of a pelvic floor symptom (pain, bowel and/or bladder) and this did not differ by colpopexy approach. The composite recurrence rate in respondents was 13.7% (7) in the abdominal group and 15.3% (15) in the vaginal group (p=.80) with an overall retreatment rate of 5.9% (3) in the abdominal and 5.2% (5) in the vaginal group (p=.85). For women ≤49 years of age, 1 in 3 will experience subjective POP recurrence and/or retreatment after apical prolapse surgery but only 5-10% will undergo retreatment. There does not appear to be a difference in the incidence of recurrence between the vaginal and abdominal routes of surgery. While 1 in 4 women report pelvic floor symptoms postoperatively, the majority report high satisfaction rates.