Risk factors for pelvic organ prolapse repair after hysterectomy.
OBJECTIVE
To estimate the incidence and identify the risk factors for pelvic organ prolapse repair after hysterectomy.


METHODS
We conducted a case-control study. We identified 6,214 women who underwent hysterectomy in our gynecology department from 1982 to 2002. Cases (n=114) were women who required pelvic organ prolapse surgery after hysterectomy from January 1982 through December 2005. Controls (n=236) were women randomly selected from the same cohort who did not require pelvic organ surgery during the same period. We performed a univariable and a multivariable analysis among 104 cases and 190 controls to identify the variables associated with prolapse repair after hysterectomy.


RESULTS
The incidence of pelvic organ prolapse that required surgical correction after hysterectomy was 1.3 per 1,000 women-years. The risk of prolapse repair was 4.7 times higher in women whose initial hysterectomy was indicated by prolapse and 8.0 times higher if preoperative prolapse grade 2 or more was present. Risk factors included preoperative prolapse grade 2 or more (adjusted odds ratio [OR] 12.6, 95% confidence interval [CI] 4.6-34.7), previous pelvic organ prolapse or urinary incontinence surgery (adjusted OR 7.9, 95% CI 1.3-48.2), history of vaginal delivery (adjusted OR 5.0, 95% CI 1.3-19.7), and sexual activity (adjusted OR 6.2, 95% CI 2.7-14.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (adjusted OR 0.7, 95% CI 0.4-1.1).


CONCLUSIONS
Preoperative pelvic organ prolapse and other factors related to pelvic floor weakness were significantly associated with subsequent pelvic floor repair after hysterectomy. Vaginal hysterectomy was not a risk factor.


METHODS
II.
Dällenbach
Patrick
P
Department of Gynecology and Obstetrics, Division of Gynecology, Urogynecology Unit, Geneva University Hospitals, Geneva, Switzerland. Patrick.Dallenbach@hcuge.ch
Kaelin-Gambirasio
Isabelle
I
Dubuisson
Jean-Bernard
JB
Boulvain
Michel
M
D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D020073:Gravidity; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D012720:Severity of Illness Index; D012725:Sexual Behavior; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000150:complications*; D014596:Uterine Prolapse / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*