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. 2022 Jul;33(7):1863-1873.
doi: 10.1007/s00192-022-05156-y. Epub 2022 Mar 21.

Long-term outcome after routine surgery for pelvic organ prolapse-A national register-based cohort study

Emil Nüssler  1 , Gabriel Granåsen  2 , Marie Bixo  2 , Mats Löfgren  2
Affiliations

Long-term outcome after routine surgery for pelvic organ prolapse-A national register-based cohort study

Emil Nüssler et al. Int Urogynecol J. 2022 Jul.

Abstract

Introduction and hypothesis: Pelvic organ prolapse (POP) is common, and women have an estimated 12-19% lifetime risk for needing POP surgery. Aims were to measure re-operation rates up to 10 years after POP surgery and patient-reported outcomes (PROMs) 5 years after a first-time operation for POP.

Methods: This is a cohort study using the Swedish National Quality Register for Gynaecological Surgery (GynOp). We retrieved information from 32,086 POP-operated women up to 10 years later. After validation, a web-based PROM questionnaire was sent to 4380 women who 5 years previously had standard POP surgery. Main outcome measures were reoperations due to a relapse of prolapse and PROMs 5 years after the primary operation.

Results: Among women operated for all types of POP, 11% had re-operations 5 years later and an additional 4% 10 years later, with similar frequencies for various compartments/types of surgery. PROMs yielded a 75% response rate after 5 years. Cure rate was 68% for anterior, 70% for posterior, and 74% for combined anterior-posterior native repairs. Patient satisfaction exceeded 70%, and symptom reduction was still significant after 5 years (p < 0.0001).

Conclusions: Following primary prolapse surgery, re-operation rates are low, even after 10 years. A web-based survey for follow-up of PROMs after POP surgery is feasible and yields a high response rate after 5 years. The subjective cure rate after primary POP operations is high, with reduced symptoms and satisfied patients regardless of compartment. Standard prolapse surgery with native tissue repair produces satisfactory long-term results.

Keywords: Follow-up studies; Kaplan-Meier estimates; Pelvic organ prolapse; Population register; Surveys and questionnaires.

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Conflict of interest statement

The authors certify that they have no affiliations with or involvement in any organizations or entities with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership in or employment by consultancies; stock ownership or other equity interests; expert testimony patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimate of all primary POP-operated patients (n = 32,086). The line underneath the curve shows the risk of retreatment up to 12 years after all primary POP operations pooled together, regardless of compartment
Fig. 2
Fig. 2
Kaplan-Meier estimates for cystocele primary operated patients (n = 13,809) with native tissue repair. The curves have been split to show the risk of relapse in the same compartment and the risk of de novo prolapse in a different vaginal compartment
Fig. 3
Fig. 3
Kaplan-Meier estimates for solely rectocele operated patients (n = 5846) with native tissue repair. The curves have been split to show the risk of relapse in the same compartment and the risk of de novo prolapse in a different vaginal compartment
Fig. 4
Fig. 4
Flow chart showing selection of participants for the Patient Reported Outcome Measures (PROM) after 5-year follow-up (n = 3283)
See this image and copyright information in PMC

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