Primary surgery of genital prolapse: a shift in treatment tradition

Abstract

The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period. A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data. The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001). The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.