Risk Factors for Prolapse Recurrence After Vaginal Repair

Abstract

One hundred seventy-six women who underwent surgical repair for vaginal prolapse (stage II or more) and incontinence and who had a 1-year postoperative examination were evaluated to identify demographic or clinical factors associated with recurrent prolapse. The pelvic organ prolapse quantification (POP-Q) staging system was used to describe vaginal prolapse. Recurrence was defined as stage II or worse at any vaginal site or the most advanced site of prolapse by centimeter measure beyond the hymen. In general, women with stage II prolapse were younger, more likely to have taken estrogen replacement therapy, and had fewer pregnancies than those with stage III or stage IV prolapse. One hundred two patients (58%) had recurrent prolapse at the 1-year follow up. Nearly all of these (n = 96, 94.1%) had stage II prolapse, including 42 with maximal extent 1 cm above the hymen, 43 with prolapse at the hymen, and 11 with prolapse 1 cm beyond the hymen. Four women had stage III (prolapse 2 cm beyond the hymen) and 2 had stage IV prolapse (stage III with vaginal length 4 cm or less). A multivariate analysis of patient characteristics found that women over 50 years of age and women with more than 1 site of preoperative prolapse had a higher rate of prolapse recurrence (P = 0.02 and P = 0.055, respectively). More women with preoperative stage III or IV prolapse (64.5%) than with preoperative stage II prolapse (50.6%) developed a recurrence, but the difference was not significant. Logistic regression analysis of patient characteristics or surgical procedures found patient age above 60 years and preoperative stage III or IV prolapse to be independently associated with recurrent prolapse at1 year (P = 0.001 and P = 0.005, respectively). Forty-seven percent of women who had 1 or 2 concomitant operative procedures had recurrent vaginal prolapse compared with 63% of those who had 3 to 7 additional procedures performed (P = 0.07). Bladder neck plication and posterior colporrhaphy were associated with anterior recurrent prolapse (P = 0.005 and P = 0.003, respectively). Bladder neck suspension, either Burch or sling, had a smaller risk of recurrent anterior vaginal prolapse (P = 0.003), and a greater risk of recurrent posterior vaginal prolapse (P = 0.008).