Factores de riesgo asociados con prolapso genital femenino: estudio de casos y controles

Abstract

ObjectivesTo assess the risk factors associated with genital prolapse and its prevalence. MethodsA retrospective, descriptive epidemiological study. The study included all adult, non-obstetric, females, who attended the outpatients and were treated in the La Sagrada Familia Department of Gynecology Clinic from 1 January 2009 to 30 June 2012. The medical records of the women to be included in the study were reviewed to confirm they fulfilled the selection criteria, as well as for the diagnosis and classification of disease. The risk factors associated with the development of genital prolapse were also assessed; ≤9 years of education, previous pelvic surgery, diabetes, age, episiotomy, constipation, occupational and recreational habits, hypothyroidism, prior hysterectomy, fetal macrosomia, menopause, multiparity, chronic lung disease, number of pregnancies (≥3), obesity, instrumental delivery (forceps), white race, and smoking. ResultsOf the 13,824 women who participated in the study, 3,681 (26.6%) had undergone hysterectomy, and genital prolapse was diagnosed in 2,193 (68.38%). Among the 10,143 (73.4%) non-hysterectomized patients, genital prolapse was diagnosed in 1,014 (31.62%). Of all the patients with prolapse (n=3,207/13,824), 1,662 (57.7%) had gradei prolapse, 978 (56.5%) gradeii prolapse, 459 (14.3%) gradeiii prolapse, and 108 (3.37%) gradeiv prolapse. Of the 3,207 patients with genital prolapse, 57% were symptomatic (n=1,828) and asymptomatic in 43% (n=1,379). The mean age of cases was 57.6±11.4 years, and 54.9 years±13 in controls. The symptoms in 84% of symptomatic patients consulting for pelvic floor dysfunction were: vaginal sensation of weight (42%), vaginal mass (27%), stress urinary incontinence (18%), 9% menometrorrhagia and urinary tract infection, and the other 4% for other gynecological conditions. The number of pregnancies ranged from 0 to 15, with a mean of 6.3±4.2, with 38% ≥6 pregnancies. The number of deliveries was between 1 and 12, with a mean of 4.8±3.9, with 45% between 1 and 3, 39% between 4 and 6 and the remaining 16% had more than 7 deliveries. The frequency of genital prolapse consultation is increasing, with symptomatic anterior prolapse being more common in older women, and obese multiparous. The associated factors were EPOC, diabetes, white race, smoking and hysterectomy prior to menopause. ConclusionsThe prolapse is and remains a public health problem, characterized by being a multifaceted phenomenon, relatively common in women of all ages. The frequency of genital prolapse gradeiii and iv is very low, and anterior prolapse is the most prevalent and the most often consulted by patients. There is also recurrence mainly in the elderly, multiparous, and with a previous abdominal hysterectomy.