title: Risk of Prolapse Recurrence after Native Tissue Anterior Vaginal Suspension Procedure with Intermediate to Long-Term Followup.
abstract: OBJECTIVE
  We report our experience with recurrence of pelvic organ prolapse after native tissue repair for stage 2 anterior prolapse.
  
  
  METHODS
  We reviewed a prospectively maintained, institutional review board approved database of women with symptomatic stage 2 anterior prolapse who underwent vaginal repair with anterior vaginal wall suspension between 1996 and 2014. Women with concurrent pelvic organ prolapse repair or hysterectomy or without 1 year followup were excluded from analysis. Failure was defined as stage 2 or greater prolapse recurrence on examination or reoperation for symptomatic pelvic organ prolapse. Outcome measures included validated questionnaires (Urogenital Distress Inventory-short form, quality of life), physical examination, standing voiding cystourethrogram at 6 months postoperatively, further surgery for pelvic organ prolapse in other compartments or for secondary stress urinary incontinence or fecal incontinence, and complications.
  
  
  RESULTS
  A total of 121 women met the study inclusion criteria with a mean followup of 5.8 ± 3.7 years. Prolapse recurrence rates were isolated anterior 7.4%, isolated apical 10.7%, isolated posterior 8.3% and multiple compartments 19%. Surgery for recurrent prolapse included anterior compartment 3.3% at 1.4 ± 1.0 years, apical 9.9% at 2.8 ± 3.0 years, posterior compartment 5.8% at 2.0 ± 1.0 years and multiple compartments 17.4% at 3.2 ± 3.3 years. There was a 1.6% rate of intraoperative complications and a 5.7% rate of 30-day complications (all Clavien I).
  
  
  CONCLUSIONS
  Anterior vaginal wall suspension for symptomatic stage 2 anterior prolapse offers a native tissue vaginal repair with minimal morbidity and a low anterior recurrence rate at intermediate to long-term followup. However, 33% of patients required secondary prolapse compartment procedures from 0.6 to 13 years later, highlighting the importance of long-term followup.
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lavelle
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Alana L
authors.initials: AL
authors.lastname: Christie
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Feras
authors.initials: F
authors.lastname: Alhalabi
authors.affiliation: UT Southwestern Medical Center, Dallas, Texas. Electronic address: philippe.zimmern@utsouthwestern.edu.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D013997:Time Factors; D014621:Vagina
keywords: pelvic organ prolapse; reconstructive surgical procedures; recurrence