Four-defect repair in women with symptomatic anterior compartment prolapse: a large cohort study

Abstract

We aimed to collect long-term follow-up data and report on both objective and subjective outcome, including morbidity, reinterventions, and sexual function following four-defect repair (FDR) as surgical correction of symptomatic anterior vaginal wall prolapse with or without stress urinary incontinence (SUI). Consecutive patients who underwent FDR between 1999 and 2005 were included in this study. We performed a retrospective analysis to evaluate anatomical and functional outcome by reviewing medical charts and sending validated questionnaires (Urogenital Distress Inventory and Defecatory Distress Inventory) to all patients. We also sent a self-developed, nonvalidated questionnaire to assess sexual function and inform the patient about reinterventions for pelvic floor dysfunction. Two hundred and twenty-nine (60%) of the 381 patients who underwent FDR participated. At a median follow-up of 40months (range 5-88), 21% of patients reported bothersome prolapse symptoms, and 11% reported bothersome SUI. Temporary postoperative urinary retention occurred in 23%. During follow-up, posterior vaginal wall prolapse was observed in 14% of patients. Overall surgical reintervention rates were 15% and 4% for (all types of) pelvic organ prolapse and SUI, respectively; dyspareunia was reported by 30%. Functional cure rates of FDR as surgical treatment for anterior vaginal wall prolapse with or without SUI are satisfying. Nevertheless, given the negative side effects of FDR (urinary retention, high reintervention rate for posterior vaginal wall prolapse, high risk of sexual dysfunction), we question the superiority of FDR over standard anterior colporrhaphy in patients with anterior vaginal wall prolapse only.