Meeting paper
AUGS paper
Pelvic organ prolapse surgery following hysterectomy on benign indications

Presented at the 28th Annual Scientific Meeting of the American Urogynecologic Society, Hollywood, FL, Sept. 27-29, 2007.
https://doi.org/10.1016/j.ajog.2008.01.012Get rights and content

Objective

The objective of the study was to determine the risk for pelvic organ prolapse surgery attributed to hysterectomy on benign indications

Study Design

In a nationwide longitudinal study, 162,488 women with hysterectomy from 1973 through 2003 were matched to 470,519 population-based control women. Hazard ratios (HR) with 95% confidence interval (CI) were calculated using Cox regression analyses.

Results

In all, 3.2% (n = 5270) of women with hysterectomy had pelvic organ prolapse surgery, compared with 2.0% (n = 9437) in nonhysterectomized controls. Compared with nonhysterectomized controls, the overall HR for prolapse surgery was 1.7 (95% CI, 1.6 to 1.7) with the highest risks observed in women having had a vaginal hysterectomy (HR 3.8; 95% CI, 3.1 to 4.8). Compared with hysterectomized women with no vaginal births, the HR for prolapse surgery was 2.0 (95% CI, 0.9 to 4.1) among women with 1 vaginal childbirth and 11.3 (95 % CI, 6.0. to 21.1) among women with at least 4 vaginal births.

Conclusion

Hysterectomy is associated with an increased risk for subsequent pelvic organ prolapse surgery with multiparous women at particular risk.

Section snippets

Materials and Methods

The Swedish Inpatient Register keeps records of the following: (1) dates of all hospital admissions and discharges; (2) up to 8 discharge diagnoses, coded according to the International Classification of Diseases (ICD) −7 until 1968, ICD-8 from 1968 through 1986, ICD-9 from 1987 through 1996, and ICD-10 thereafter; and (3) up to 12 operation codes from the Swedish Classification of Operations and Major Procedures. The registry was established in 1964; in 1973 the registry covered more than 60%

Results

During the observational period, 162,488 women with hysterectomy fulfilled the inclusion criteria and were individually matched to 470,519 women without hysterectomy. The cohorts were followed up for an average of 11.9 years (SD ± 8.0) and 12.1 years (SD ± 7.9), respectively. In all, 3.2% (n = 5270) of women with hysterectomy had pelvic organ prolapse surgery, compared with 2.0% (n =,437) in the nonhysterectomized control group. The overall hysterectomy rate on benign indications increased by

Comment

Our population-based findings confirm the association between hysterectomy on benign indications and an increased risk for pelvic organ prolapse surgery. A major limitation of previous studies on the subject is that they rarely differentiate between various modes and routes of hysterectomy,4, 10, 11 and therefore, the relative importance of specific surgical techniques have been unknown.

In the present study, women with vaginal hysterectomy had the highest rates of subsequent pelvic organ

References (19)

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    Citation Excerpt :

    The impact of route of hysterectomy on subsequent prolapse has been previously debated, however it is still not well established. In a nationwide longitudinal study, Altman et al18 reported a rate of subsequent prolapse in 564 (per 100,000 person-years) women undergoing abdominal surgery, 679 after vaginal and 287 after laparoscopic hysterectomy. Recently, a study using the Danish National Patient Registry with a 20-year follow-up showed that the highest cumulative incidence of POP surgery was after vaginal hysterectomy (14%) with approximately 6% for laparoscopic or abdominal hysterectomy.19

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Cite this article as: Altman D, Falconer C, Cnattingius S, et al. Pelvic organ prolapse surgery following hysterectomy on benign indications. Am J Obstet Gynecol 2008;198:572.e1-572.e6.

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