Pelvic organ prolapse surgery after different hysterectomy methods: a population-based cohort study

Abstract

Background: Pelvic floor disorders are expected to greatly increase in the coming years. Many factors have been implicated in the development of pelvic organ prolapse (POP). In the last decade, the route of hysterectomy performed has shifted more towards robotic/laparoscopic techniques, and the role that the hysterectomy route plays in the need for future POP repair remains uncertain. Here the authors investigate the association of POP repair following robotic/laparoscopic hysterectomies, as well as vaginal, supracervical, and abdominal modalities. Results: Patients living in the West were more likely to have a prolapse repair post-hysterectomy than those living in the Midwest (HR 1.39; 95% CI: 1.01-1.93). Patients with hospital stays ≥ 4 days following hysterectomies were more likely to require future prolapse repairs than those with ≤ 1-day stays (HR 1.71; 95% CI: 1.10-2.65). Compared to abdominal procedures, robotic/laparoscopic modalities were more likely to be associated with prolapse within 18 months of hysterectomies (HR 1.72, 95% CI: 1.13-2.61). However, between 18 and 36 months, both supracervical and vaginal hysterectomies were more likely to be associated with prolapse surgeries (HR 1.96, 95% CI: 1.15-3.34 and HR 1.94; 95% CI: 1.02-3.70, respectively). Conclusions: Region and length of hospital stay significantly impacted the need for future prolapse repair. Among modalities, the association with prolapse repair changes with time.