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).

Design: Long-term follow-up study of a randomised controlled multicentre study.

Setting: Seven hospitals and one private clinic in the south-east of Sweden.

Population: 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.

Main outcome measures: 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.

Keywords: Hysterectomy; long-term follow-up; pelvic organ prolapse; pelvic organ prolapse-quantification; randomised trial.