title: Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery.
abstract: OBJECTIVE
  This study aims to determine the risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery related to mode of hysterectomy focusing on vaginal hysterectomy.
  
  
  METHODS
  We performed a nationwide cohort study. Women exposed to hysterectomy on benign indications (n = 118,601) were compared to women unexposed to hysterectomy (n = 579,200). The outcome was defined as first occurrence of POP or SUI surgery. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs) using Cox proportional-hazards models.
  
  
  RESULTS
  The greatest risks of POP (HR 4.9, 95% CI 3.4-6.9) or SUI surgery (HR 6.3, 95% CI 4.4-9.1) were observed subsequent to vaginal hysterectomy for pelvic organ prolapse. Having a vaginal hysterectomy for other reasons also significantly increased the risks of POP and SUI surgery compared to other modes of hysterectomy.
  
  
  CONCLUSIONS
  Hysterectomy in general, in particular vaginal hysterectomy, was associated with an increased risk for subsequent POP and SUI surgery.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden. catharina.forsgren@ds.se
authors.forename: Catharina
authors.initials: C
authors.lastname: Forsgren
authors.forename: Cecilia
authors.initials: C
authors.lastname: Lundholm
authors.forename: Anna L V
authors.initials: AL
authors.lastname: Johansson
authors.forename: Sven
authors.initials: S
authors.lastname: Cnattingius
authors.forename: Jan
authors.initials: J
authors.lastname: Zetterström
authors.forename: Daniel
authors.initials: D
authors.lastname: Altman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000209:etiology*; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000601:surgery*; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013548:Sweden; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*