nach oben

International Urogynecology Journal

Erschienen in:

01.09.2020 | Original Article

Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience

verfasst von: Sybil Mairesse, Emmanuel Chazard, Géraldine Giraudet, Michel Cosson, Stéphanie Bartolo

Erschienen in: International Urogynecology Journal | Ausgabe 9/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

The surgical treatment of pelvic organ prolapse (POP) is associated with specific complications. Our primary objective was to assess the recurrence requiring reoperation after prolapse surgery, and our secondary objectives were to assess the early complications and secondary surgery for urinary incontinence.

Methods

Retrospective study of a population-based cohort of all hospital or outpatient stays including POP surgery from 2008 to 2014, using the French nationwide discharge summary database. We calculated the rates of hospital readmission following surgery as well as the rates of reoperation for recurrent prolapse and subsequent procedures performed for urinary incontinence.

Results

A total of 310,938 patients had undergone surgery for POP. Two hundred fourteen (0.07%) patients died, and 0.45% were admitted to an intensive care unit; 4.4% of the patients underwent surgery for the recurrence of prolapse. Concomitant hysterectomy in the first surgery was associated with a significantly lower risk of POP surgery recurrence: (hazard ratio (HR) [95% confidence interval (CI)] = 0.51 [0.49; 0.53]). A total of 1386 (2.5%) patients were readmitted to the hospital for early (30-day) complications of prolapse surgery. The most frequent reasons for early readmission were local infection (32.8%), hemorrhage (21.4%) and pain (17.2%). Risk factors for complications were obesity, hospitals with low levels of activity and associated incontinence surgery; 4.6% of the patients required secondary surgery for urinary incontinence; obesity was a risk factor (HR [95% CI] = 1.12 [1.01; 1.24]), and the vaginal route was a protective factor (odds ratio = 1.86 for laparoscopy, 1.44 for laparotomy and 1.25 for multiple approaches).

Conclusions

POP surgery is associated with low rates of complication and recurrence. Complications occurred most commonly following combined surgeries for both prolapse and incontinence and in hospitals with low surgical volumes. Concomitant hysterectomy appears to be protective for the need for additional prolapse surgery, and the vaginal route leads to a lower frequency of secondary surgery for urinary incontinence.

Nur mit Berechtigung zugänglich

Maher CF, Baessler KK, Barber MD, Cheong C, Consten ECJ, Cooper KG, et al. Surgical management of pelvic organ prolapse. Climacteric J Int Menopause Soc. 2019;22:229–35. https://doi.org/10.1080/13697137.2018.1551348.CrossRef

Abbott S, Unger CA, Evans JM, Jallad K, Mishra K, Karram MM, et al. Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014;210:163.e1–8. https://doi.org/10.1016/j.ajog.2013.10.012.CrossRef

Barski D, Deng DY. Management of mesh complications after SUI and POP repair: review and analysis of the current literature. Biomed Res Int. 2015;2015:831285. https://doi.org/10.1155/2015/831285.CrossRefPubMedPubMedCentral

Hokenstad ED, Glasgow AE, Habermann EB, Occhino JA. Readmission and reoperation after surgery for pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2017;23:131–5. https://doi.org/10.1097/SPV.0000000000000379.CrossRefPubMed

Barski D, Otto T, Gerullis H. Systematic review and classification of complications after anterior, posterior, apical, and total vaginal mesh implantation for prolapse repair. Surg Technol Int. 2014;24:217–24.PubMed

For the Systematic Review Group of the Society of Gynecologic Surgeons, Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, et al. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011;22:789–98. https://doi.org/10.1007/s00192-011-1384-5.CrossRef

Kasyan G, Abramyan K, Popov AA, Gvozdev M, Pushkar D. Mesh–related and intraoperative complications of pelvic organ prolapse repair. Cent Eur J Urol. 2014;67:296–301. https://doi.org/10.5173/ceju.2014.03.art17.CrossRef

Boudemaghe T, Belhadj I. Data resource profile: the French National Uniform Hospital Discharge Data set Database (PMSI). Int J Epidemiol. 2017;46:392–392d. https://doi.org/10.1093/ije/dyw359.CrossRefPubMed

WHO | International Classification of Diseases, 11th Revision (ICD-11). WHO n.d. http://www.who.int/classifications/icd/en/. Accessed 31 July 2019.

10.

Social Security. French comon classification of medical procedures - CCAM n.d. n.d. http://www.ameli.fr/accueil-de-la-ccam/index.php. Accessed 31 July 2019.

11.

Lucot J-P, Cosson M, Bader G, Debodinance P, Akladios C, Salet-Lizée D, et al. Safety of vaginal mesh surgery versus laparoscopic mesh sacropexy for cystocele repair: results of the prosthetic pelvic floor repair randomized controlled trial. Eur Urol. 2018;74:167–76. https://doi.org/10.1016/j.eururo.2018.01.044.CrossRefPubMed

12.

Salvatore S, Siesto G, Serati M. Risk factors for recurrence of genital prolapse. Curr Opin Obstet Gynecol. 2010;22:420–4. https://doi.org/10.1097/GCO.0b013e32833e4974.CrossRefPubMed

13.

Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, et al. Identification of risk factors for genital prolapse recurrence. Neurourol Urodyn. 2009;28:301–4. https://doi.org/10.1002/nau.20639.CrossRefPubMed

14.

Dallas K, Elliott CS, Syan R, Sohlberg E, Enemchukwu E, Rogo-Gupta L. Association between concomitant hysterectomy and repeat surgery for pelvic organ prolapse repair in a cohort of nearly 100,000 women. Obstet Gynecol. 2018;132:1328–36. https://doi.org/10.1097/AOG.0000000000002913.CrossRefPubMed

15.

Meriwether KV, Balk EM, Antosh DD, Olivera CK, Kim-Fine S, Murphy M, et al. Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines. Int Urogynecol J. 2019;30:505–22. https://doi.org/10.1007/s00192-019-03876-2.CrossRefPubMed

16.

Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M, et al. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol. 2018;219:129–146.e2. https://doi.org/10.1016/j.ajog.2018.01.018.CrossRefPubMed

17.

de Oliveira SA, Fonseca MCM, Bortolini MAT, Girão MJBC, Roque MT, Castro RA. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis. Int Urogynecol J. 2017;28:1617–30. https://doi.org/10.1007/s00192-017-3433-1.CrossRefPubMed

18.

Vandendriessche D, Sussfeld J, Giraudet G, Lucot J-P, Behal H, Cosson M. Complications and reoperations after laparoscopic sacrocolpopexy with a mean follow-up of 4 years. Int Urogynecol J. 2017;28:231–9. https://doi.org/10.1007/s00192-016-3093-6.CrossRefPubMed

19.

Warembourg S, Labaki M, de Tayrac R, Costa P, Fatton B. Reoperations for mesh-related complications after pelvic organ prolapse repair: 8-year experience at a tertiary referral center. Int Urogynecol J. 2017;28:1139–51. https://doi.org/10.1007/s00192-016-3256-5.CrossRefPubMed

20.

Alas AN, Chinthakanan O, Espaillat L, Plowright L, Davila GW, Aguilar VC. De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence. Int Urogynecol J. 2017;28:583–90. https://doi.org/10.1007/s00192-016-3149-7.CrossRefPubMed

21.

Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J. 2013;24:485–91. https://doi.org/10.1007/s00192-012-1888-7.CrossRefPubMed

22.

Ennemoser S, Schönfeld M, von Bodungen V, Dian D, Friese K, Jundt K. Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J. 2012;23:851–5. https://doi.org/10.1007/s00192-012-1765-4.CrossRefPubMed

23.

Al-Mandeel H, Ross S, Robert M, Milne J. Incidence of stress urinary incontinence following vaginal repair of pelvic organ prolapse in objectively continent women. Neurourol Urodyn. 2011;30:390–4. https://doi.org/10.1002/nau.20947.CrossRefPubMed

24.

Guillibert F, Chêne G, Fanget C, Huss M, Seffert P, Chauleur C. Risk factors of mesh exposure after transvaginal repair of genital prolapse. Gynecol Obstet Fertil. 2009;37:470–5. https://doi.org/10.1016/j.gyobfe.2009.04.010.CrossRefPubMed

25.

Sabadell J, Salicrú S, Montero-Armengol A, Rodriguez-Mias N, Gil-Moreno A, Poza JL. External validation of de novo stress urinary incontinence prediction model after vaginal prolapse surgery. Int Urogynecol J. 2019;30:1719–23. https://doi.org/10.1007/s00192-018-3805-1.CrossRefPubMed

26.

Khayyami Y, Elmelund M, Lose G, Klarskov N. De novo urinary incontinence after pelvic organ prolapse surgery-a national database study. Int Urogynecol J. 2019. https://doi.org/10.1007/s00192-019-04041-5.

Titel: Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience
verfasst von: Sybil Mairesse
Emmanuel Chazard
Géraldine Giraudet
Michel Cosson
Stéphanie Bartolo
Publikationsdatum: 01.09.2020
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 9/2020
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04210-6

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

28.05.2024 Kinder- und Jugendgynäkologie Nachrichten

Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

26.05.2024 Mammakarzinom Nachrichten

Frauen, die zum Zeitpunkt der Brustkrebsdiagnose eine hohe mammografische Brustdichte aufweisen, haben ein erhöhtes Risiko für ein baldiges Rezidiv, legen neue Daten nahe.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Fehlerkultur in der Medizin – Offenheit zählt!

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

Update Gynäkologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2020

Pelvic organ prolapse in Northwest Ethiopia: a population-based study

Association between sexual intercourse frequency and pelvic floor muscle morphology in pregnant women

Time-frame comparison of hystero-preservation in the surgical treatment of uterine prolapse: a population-based nation-wide follow-up descriptive study, 2006–2013 versus 1997–2005

First-line treatment of pelvic organ prolapse and discontinuation of pessary treatment

Risk factors and prevalence of urinary incontinence in mid-life Singaporean women: the Integrated Women’s Health Program

Impact of the EPISCISSORS-60 mediolateral episiotomy scissors on obstetric anal sphincter injuries: a 2-year data review in the United Kingdom

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Alter der Mutter beeinflusst Risiko für kongenitale Anomalie

Fehlerkultur in der Medizin – Offenheit zählt!

Mammakarzinom: Brustdichte beeinflusst rezidivfreies Überleben

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

Update Gynäkologie