title: Recurrence risk is associated with preoperatively advanced prolapse stage: Is there a difference between women with stage 2 and those with stage 3 or 4 cystocele?
abstract: OBJECTIVE
  Pelvic organ prolapse (POP) recurrence after surgery is a major problem. POP that is more advanced preoperatively is associated with a higher risk of recurrence postoperatively. We hypothesized that women with a stage 2 cystocele differ from those with a stage 3 or 4 cystocele. The aim of this study was to compare the baseline characteristics of women with mild and those with more advanced cystocele.
  
  
  METHODS
  Patients had participated in one of two multicenter prospective cohort studies on women undergoing conventional anterior colporrhaphy without previous POP surgery. This was a secondary analysis of these data. Women with a preoperative cystocele stage 2 were compared with women with a stage 3 or 4 cystocele. Logistic regression models were employed to calculate odds ratios (OR) and 95% confidence intervals (CI).
  
  
  RESULTS
  Two hundred and sixty-nine women were assessed, of whom 132 (49.1%) had an advanced cystocele. Only older age was significantly associated with advanced cystocele preoperatively, with an OR of 1.07 (95% CI 1.04-1.10). There were no significant differences between women with advanced or stage 2 cystocele in body mass index, vaginal deliveries, assisted delivery, positive family history of POP, concurrent rectocele, concurrent uterine of vaginal vault prolapse, major levator ani muscle defects, or levator hiatal area.
  
  
  CONCLUSIONS
  Women with advanced cystocele were significantly older than women with stage 2 cystocele. This raises the question whether it would be favorable to perform POP surgery in an earlier stage, i.e., at a younger age, in order to prevent POP recurrence.
authors.affiliation: Obstetrics & Gynecology, Radboud University Medical Center, P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands. Tineke.Vergeldt@radboudumc.nl.
authors.forename: Tineke F M
authors.initials: TFM
authors.lastname: Vergeldt
authors.affiliation: Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Kim J B
authors.initials: KJB
authors.lastname: Notten
authors.affiliation: Obstetrics & Gynecology, Radboud University Medical Center, P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
authors.affiliation: Obstetrics & Gynecology, Zuyderland Medical Center, Heerlen, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Weemhoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence
keywords: Advanced stage; Age; Pelvic organ prolapse; Recurrence