Our Recurrence Ratios in Pelvic Organ Prolapse Surgical Repair

ABSTRACT INTRODUCTION: The objective of this study was to assess the recurrence ratios of pelvic organ prolapse surgical repair. METHODS: Between June 2012 and May 2017, 126 nonrandomly selected women underwent pelvic organ prolapse surgical repair. We used POP-Q System for staging. The patients were divided into four groups as follows; anterior repair group (n=64), posterior repair group (n=29), anteriorposterior repair group (n=13), and vaginal cuff prolapse group (n=20). RESULTS: Mean age of the 126 patients was 58.5 ± 10.8 years (min. 42, max. 75), while mean weight was 70 ±12.7 kg (min. 48 kg, max. 92 kg) and mean parity was 3 (min. 0, max. 6). Our recurrence ratios were 8 patients (12.5%) in anterior repair group, 7 patients (24.1%) in posterior repair group, 1 patient (7.6%) in anterior-posterior repair group, and no patients in vaginal cuff prolapse group. In all cases, the overall recurrence ratio was 12.69%. DISCUSSION and CONCLUSION: A significant relationship between menopause and POP recurrence was determined. A significant relationship between surgical technique and recurrence free cases was also detected.

Pelvik Organ Prolapsusu Cerrahi Onarımında Nüks Oranlarımız

ÖZ ÖZ GİRİŞ ve AMAÇ: Bu çalışmanın amacı, pelvik organ prolapsusu cerrahi onarımının nüks oranlarını değerlendirmektir. YÖNTEM ve GEREÇLER: Haziran 2012 ile Mayıs 2017 tarihleri arasında rastgele seçilen 126 kadına pelvik organ prolapsusu cerrahi onarımı yapıldı. Evreleme için POP-Q Sistemini kullandık. Hastalar dört gruba ayrıldı; ön onarım grubu (n = 64), arka onarım grubu (n = 29), ön-arka onarım grubu (n = 13) ve vajen kubbe prolapsusu grubu (n = 20). BULGULAR: 126 hastanın yaş ortalaması 58.5 ± 10.8 yıl (en az 42, en fazla 75), ortalama ağırlık 70 ± 12.7 kg (en az 48 kg, en fazla 92 kg) ve ortalama parite 3 (en az 0, en fazla 6) idi. Nüks oranlarımız ön onarım grubunda 8 (%12.5), arka onarım grubunda 7 (%24.1), ön-arka onarım grubunda 1 (%7.6), vajen kubbe prolapsusu grubunda hiçbir hasta yok şeklinde idi. Tüm durumlarda, genel nüks oranı %12.69 idi. TARTIŞMA ve SONUÇ: Menopoz ile POP nüksü arasında anlamlı ilişki tespit edilmiştir. Ayrıca cerrahi teknik ile nükssüz olgular arasında da anlamlı bir ilişki bulunmuştur

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1. Beckmann CRB, Ling FW, Barzansky BM, Herbert WNP, Laube DW, Smith RP. Obstetrics and gynecology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. Pelvic support defects, urinary incontinence, and urinary tract infection; 259- 67.

2. Padubidri VG, Daftary SN. Shaw’s textbook of gynecology. 16th ed. Haryana, India: Reed Elsevier India Private Limited; 2015. Genital prolapse; 349-64.

3. Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) - A New Era in Pelvic Prolapse Staging. J Med Life 2011; 4 (1): 75-81.

4. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence. Obstet Gynecol 1997; 89 (4): 501–6. doi:10.1016/s0029- 7844(97)00058-6

5. Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, et al. Defining Success after Surgery for Pelvic Organ Prolapse. Obstet Gynecol 2009; 114 (3): 600-9.

6. Moore RD, Miklos JR. Vaginal Mesh Kits for Pelvic Organ Prolapse, Friend or Foe: A Comprehensive Review. The Scientific World Journal 2009; 9: 163- 189.

7. Vergeldt TFM, Weemhoff M, IntHout J. Kluivers KB. Risk Factors for Pelvic Organ Prolapse and its Recurrence: A Systemic Review. Int Urogynecol J. 2015; 26 (11): 1559–1573. doi: 10.1007/s00192-015-2695-8.

8. Kim CM, Jeon MJ, Chung DJ, Kim SK, Kim JW, Bai SW. Risk Factors for Pelvic Organ Prolapse. Int J Gynaecol Obstet. 2007; 98 (3): 248-51.

9. Whiteside JL, Weber AM, Meyn LA. Walters MD. Risk Factors for Prolapse Recurrence after Vaginal Repair. Am J Obstet Gynecol. 2004; 191 (5): 1533-8

10. Diez-Itza I, Aizpitarte I, Becerro A. Risk Factors for the Recurrence of Pelvic Organ Prolapse after Vaginal Surgery: A Review at 5 Years after Surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18 (11): 1317-24.

11. Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk Factors for Pelvic Organ Prolapse and its Recurrence: A Systematic Review. Int Urogynecol J 2015; 26 (11): 1559-73.

12. Vergeldt TFM, Notten KJB, Kluivers KB, Weemhoff M. 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? Int Urogynecol J. 2017; 28 (7): 983-7.

13. Halpern-Elenskaia K, Umek W, BodnerAdler B, Hanzal E. Anterior Colporrhaphy: A Standard Operation? Systematic Review of the Technical Aspects of a Common Procedure in Randomized Controlled Trials. Int Urogynecol J. 2018; 29: 781-8. doi: 10.1007/s00192-017-3510-5.

14. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence. Obstet Gynecol 1997; 89 (4): 501-6.

15. Sand PK, Koduri S, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ, et al. Prospective Randomized Trial of Polyglactin 910 Mesh to Prevent Recurrence of Cystoceles and Rectoceles. Am J Obstet Gynecol 2001; 184 (7): 1357-62.

16. Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior Colporrhaphy: a Randomized Trial of three Surgical Techniques. Am J Obstet Gynecol 2001; 185 (6): 1299-304.

17. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical Innovation without Evaluation: The Ideal Recommendations. Lancet 2009; 374 (9695): 1105- 12. doi: 10.1016/S0140-6736(09)61116-8.

18. Foon R, Toozs-Hobson P, Latthe PM. Adjuvant Materials in Anterior Vaginal Wall Prolapse Surgery: A Systematic Review of Effectiveness and Complications. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (12): 1697-706. doi: 10.1007/s00192-008-0668-x.

19. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk Factors for Prolapse Recurrence after Vaginal Repair. Am J Obstet Gynecol 2004; 191 (5): 1533-8.

20. Lefevre R, Davila GW. Functional Disorders: Rectocele. Clin Colon Rectal Surg. 2008; 21 (2): 129-37. doi: 10.1055/s-2008-1075862.

21. Töz E, Özcan A, Apaydın N, Uyar İ, Kocakaya B, Okay G. Outcomes of Vaginal Hysterectomy and Constricting Colporrhaphy with Concurrent Levator Myorrhaphy and High Perineorrhaphy in Women Older than 75 Years of Age. Clin Interv Aging. 2015; 10: 1009-15. doi: 10.2147/CIA.S85960.

22. DeLancey JOL. Anatomy and Biomechanics of Genital Prolapse. Clin Obstet Gynecol 1993; 36: 897- 909.

23. Uzoma A, Farag KA. Vaginal Vault Prolapse. Obstet Gynecol Int 2009; 275621. doi: 10.1155/2009/275621.

24. Maher C, Feiner B, Baessler K, Schmid C. Surgical Management of Pelvic Organ Prolapse in Women. 2010; 30 (4):CD004014. doi: 10.1002/14651858.CD004014.pub5.

25. Choi KH, Hong JY. Management of Pelvic Organ Prolapse. Korean J Urol. 2014; 55 (11): 693- 702. 10.4111/kju.2014.55.11.693.

26. Kong MK, Bai SW. Surgical Treatments for Vaginal Apical Prolapse. Obstet Gynecol Sci. 2016; 59: 253-260. doi: 10.5468/ogs.2016.59.4.253.

27. Webb MJ, Aronson MP, Ferguson LK, Lee RA. Posthysterectomy Vaginal Vault Prolapse: Primary Repair in 693 Patients. Obstet Gynecol 1998; 92 (2): 281-5.

28. Sze EH, Karram MM. Transvaginal Repair of Vault Prolapse: A Review. Obstet Gynecol 1997; 89 (3): 466- 75. doi: 10.1016/S0029-7844(96)00337- 7.

29. Limb J, Wood K, Weinberger M, Miyazaki F, Aboseif S. Sacral Colpopexy Using Mersilene Mesh in the Treatment of Vaginal Vault Prolapse. World J Urol 2005; 23 (1): 55-60. doi: 10.1007/s00345-004-0457-1.

30. Food and Drug Administration. Obstetrical and Gynecological Devices; Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair; Final Order. Fed Regist 2016; 81 (2): 353-61.