Long-term outcomes of surgical interventions for different types of pelvic organ prolapse

Abstract

Background. The study aimed to comparatively analyze the nature and frequency of complications and the severity of recurrences among patients with different forms of pelvic organ prolapse (POP). These factors will be examined depending on the surgical technique employed.
 Materials and methods. The study involved a thorough clinical evaluation, surgical intervention, and outpatient monitoring (at 1, 6, 12, 24, and 36 months) of 523 participants, aged 32–80 years, categorized into four main groups and 3–4 subgroups depending on the type of POP and surgical method used. Group 1 comprised 161 women (30.8%) presenting with grade I–III cervical elongation combined with grade I–II anterior vaginal wall prolapse. Group 2 consisted of 207 (39.6%) patients with grade II–III anterior vaginal wall prolapse, whereas group 3 included 107 patients (20.5%) with complete uterine prolapse. Group 4 was made up of 48 women (9.1%) with grade II–III posterior vaginal wall descent.
 Results. Based on the acquired data, synthetic implant extrusion commonly took place 6–12 months after the surgical procedure. Of the 158 patients who received polypropylene endoprostheses, 20 (12.7%) experienced extrusion and required repeated hospitalizations for partial or complete excision, followed by restoration of vaginal wall integrity. POP recurrences typically occurred 12–36 months after surgical treatment and were detected in 69 (13.2%) of 523 patients. The reappearance of symptoms of pelvic organ descent was most commonly identified in patients who underwent surgery using their tissues (26.6%), less frequently with synthetic implants (12.7%), and extremely rarely with titanium endoprostheses (1.6%).
 Conclusions. The results revealed that patients, who underwent surgery using original techniques, employing titanium-made mesh implants and anchors, experienced the fewest complications and postoperative POP incidence. Conversely, the use of synthetic implants increases the likelihood of mesh-associated complications and disease recurrence, necessitating partial or complete excision. The use of autologous tissue for POP surgery is related to a higher likelihood of recurring prolapse symptoms.