title: Recurrence of vaginal prolapse after total vaginal hysterectomy with concurrent vaginal uterosacral ligament suspension: comparison between normal-weight and overweight women.
abstract: BACKGROUND
  Obesity is one of the most important risk factors for the development and progression of the pelvic organ prolapse. However, data regarding whether obesity is a risk factor for recurrence after pelvic organ prolapse surgery are controversial.
  
  
  OBJECTIVE
  The aim of this study was to estimate the risk of recurrent prolapse in any vaginal compartment after total vaginal hysterectomy with concurrent uterosacral ligament vaginal vault suspension among normal-weight women compared with either overweight or obese women.
  
  
  METHODS
  This is a 5-year retrospective cohort study of women who underwent total vaginal hysterectomy with concurrent vaginal uterosacral ligament suspension at one referral center for pelvic organ prolapse in Italy from January 2010 to January 2015. All women who underwent total vaginal hysterectomy with concurrent uterosacral ligament suspension were included in the analysis. Laparoscopic approach was excluded. Women were classified according to the body mass index of 2 groups: (1) normal weight (body mass index, 18.5-24.9 kg/m2) and (2) either overweight (body mass index, 25.0-29.9 kg/m2) or obese (body mass index, ≥30.0 kg/m2). The primary outcome was the incidence of recurrent prolapse in any vaginal compartment (anterior, posterior, or apical). Recurrent prolapse was defined as prolapse extending beyond the hymen with straining (pelvic organ prolapse quantification points Ba, C, Bp ≥0) or repeat treatment for prolapse with either pessary or surgery. Uterosacral ligament suspensions were performed with a vaginal approach with the use of sutures placed in the intermediate uterosacral ligament, at or above the ischial spine, and affixed to the vaginal apex. Delayed absorbable sutures were used, with 2 sutures per side.
  
  
  RESULTS
  Three hundred sixty women who underwent total vaginal hysterectomy with concurrent uterosacral ligament suspension with at least 6 months of follow up after surgery were included in the study. The overall incidence of recurrent prolapse in any vaginal compartment was 19.7% (71/360 women). The risk of recurrent prolapse in any vaginal compartment (ie, primary outcome) was similar in the normal-weight compared with the overweight or obese group (16.7% vs 21.3%; P=.30). Women in the normal-weight group had a lower risk of recurrent anterior vaginal prolapse (10.8% vs 20.0%; adjusted odds ratio, 0.49; 95% confidence interval, 0.25-0.94) and of multiple compartment prolapse (8.3% vs 14.6%; adjusted odds ratio, 0.53; 95% confidence interval, 0.31-0.83).
  
  
  CONCLUSIONS
  After total vaginal hysterectomy with concurrent uterosacral ligament suspension, the risk of recurrent vaginal prolapse was 20% based on a composite outcome definition of any anatomic prolapse beyond the hymen or pessary or repeat surgery. The most common site of recurrence was the anterior compartment. The risk of recurrent surgery was 10%. Our study showed that women with normal-weight had similar risk of recurrent prolapse compared with the overweight or obese group. In subgroup analyses, women with normal-weight had one-half the odds of recurrent anterior vaginal wall prolapse compared with those who were overweight or obese.
authors.affiliation: Department of Obstetrics and Gynecology, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Rappa
authors.affiliation: Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy. Electronic address: gabriele.saccone.1990@gmail.com.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014596:Uterine Prolapse / Q000453:epidemiology / Q000601:surgery*
keywords: cistoscopy; incontinence; mesh; prolapse; urology