Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation.
BACKGROUND
To identify risk factors in recurrence and to evaluate anatomic and functional results of vaginal sacrospinous ligament fixation and pelvic floor reconstruction for genital prolapse.


METHODS
One hundred and thirty-eight women underwent surgery for uterovaginal or vault prolapse. Follow-up data were available for 122 cases; 83% were examined and others were interviewed by telephone. The median (range) follow-up was 24 (1-141) months. Cox regression was used to identify risk factors associated with recurrence; uni- and multivariate regression was used to identify risk factors underlying postoperative infections because infections were found to be a risk factor of recurrence. Recurrence-free survival was estimated using the Kaplan-Meier method.


RESULTS
Seven (5%) patients suffered severe cardiopulmonary complications including one postoperative death due to a pulmonary embolism. Twenty-six (21%) patients suffered a recurrence, 14 with cystocele. Ten patients with recurrence were symptomatic and six underwent a re-operation. The Cox regression model showed that vaginal cuff infection raised the odds ratio (OR) for recurrence to 6.13 [confidence interval (CI) 1.80-20.83] and urinary tract infection to 3.65 (CI 1.40-9.47). In both uni- and multivariate analysis, lack of intravenous antibiotic prophylaxis, age less than 73 years and vaginal ulcerations were statistically significant risk factors for postoperative infection. Eleven (33%) out of 33 sexually active women reported improvement and three (9%) complained of dyspareunia.


CONCLUSIONS
Transvaginal sacrospinous ligament fixation with pelvic floor repair is an effective means of correcting both vault prolapse and uterine procidentia. Women who wish to preserve coital function will also benefit from this operation. Postoperative infection is an independent and most important individual risk factor underlying recurrence. Prophylactic antibiotics seem to be effective in reducing the rate of postoperative infections.
Nieminen
Kari
K
Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School and School of Public Health, University of Tampere, Tampere, Finland. kn37975@uta.fi
Huhtala
Heini
H
Heinonen
Pentti K
PK
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D001956:Broad Ligament / Q000601:surgery*; D005260:Female; D005387:Finland; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D017773:Pelvic Floor / Q000601:surgery; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000209:etiology; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012445:Sacrococcygeal Region / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014552:Urinary Tract Infections / Q000209:etiology; D014596:Uterine Prolapse / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*