title: Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study.
abstract: OBJECTIVE
  To analyse the development of pelvic organ prolapse (POP) after subtotal (SH) and total hysterectomy (TH) in the long-term, and to assess patient-reported symptoms regarding pelvic floor dysfunction (PFD).
  
  
  METHODS
  Long-term follow-up study of a randomised controlled multicentre study.
  
  
  METHODS
  Seven hospitals and one private clinic in the south-east of Sweden.
  
  
  METHODS
  Of the 184 women who were eligible from the original trial, 151 (82%) responded to a postal questionnaire and 128 (70%) were clinically examined.
  
  
  METHODS
  Postal questionnaire using the short-form version of the Pelvic Floor Distress Inventory (PFDI-20) and clinical examination using the POP-Q system. Multivariate analyses were used.
  
  
  METHODS
  POP-Q measurements and symptoms of PFD.
  
  
  RESULTS
  Follow-up time was a median of 11.3 years. Less than 3% had stage-3 prolapse. No significant difference was found in the presence of stage-2 or higher stage prolapse between the two hysterectomy groups (39% in SH versus 37% in TH; OR 1.28, 95% CI 0.59-2.80). Nor was there any significant difference in the quality-of-life measurement between the SH and TH groups [summary score PFDI-20: median 93 (range 60-201) versus 87 (range 60-186); Fisher's protected least significant difference post hoc test, P = 0.78 ). None of the symptoms of PFD revealed statistically significant differences between the hysterectomy groups.
  
  
  CONCLUSIONS
  This long-term follow-up study of PFD showed basically no significant differences in subjective or objective measurements of POP, or in specific pelvic floor quality-of-life aspects after SH and TH. However, because of the low statistical power the results are inconclusive. Larger trials, and probably also a longer follow-up period, are necessary.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Persson
authors.forename: J
authors.initials: J
authors.lastname: Brynhildsen
authors.forename: P
authors.initials: P
authors.lastname: Kjølhede
mesh_terms: D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D059952:Pelvic Floor Disorders / Q000209:etiology; D056887:Pelvic Organ Prolapse / Q000209:etiology*; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Hysterectomy; long-term follow-up; pelvic organ prolapse; pelvic organ prolapse-quantification; randomised trial