A comparison of women with primary and recurrent pelvic prolapse,☆☆

Presented at the Sixty-sixth Annual Meeting of The Central Association of Obstetricians and Gynecologists, Kansas City, Missouri, October 15-17, 1998.
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Abstract

Objective: Our purpose was to identify clinically relevant differences in women with primary and recurrent pelvic organ prolapse. Study Design: Consecutive women undergoing reconstructive surgery completed a urogynecologic history and physical examination and underwent either multichannel urodynamic testing or pelvic floor fluoroscopy, or both. Two groups were compared: primary (no prior surgery for pelvic organ prolapse) and recurrent. Results: One hundred eighty-one consecutive women were studied—103 with primary and 78 with recurrent prolapse. The groups were similar with respect to age, race, weight, vaginal parity, prolapse stage, urodynamic diagnosis, extent of visceral malposition, and common urinary, anorectal, and sexual symptoms. Clinically relevant differences were found, with the recurrent group having shorter vaginal lengths (P = .0005), being more likely to have had a hysterectomy for a nonprolapse indication (P = .00018) and to be receiving hormone replacement therapy (P = .00003). Conclusion: The women with primary and recurrent pelvic organ prolapse in this population were remarkably similar in many quantifiable parameters measured. The clinical differences may be related to previous surgery for pelvic organ prolapse. (Am J Obstet Gynecol 1999;180:1415-8.)

Section snippets

Material and methods

The charts of all women who underwent reconstructive surgery for pelvic organ prolapse between May 1995 and February 1997 at our tertiary care referral practice were reviewed. All women completed a comprehensive urogynecologic history and a physical examination, with the maximum extent of pelvic organ prolapse quantified according to the standardized Pelvic Organ Prolapse Quantitation system.2 Unless the vagina was completely everted in the supine position, all women were assessed in the

Results

One hundred eighty-one consecutive women, who ultimately underwent surgery for symptomatic pelvic organ prolapse at our tertiary care referral practice, formed the study population. Women who were treated nonsurgically were not included. Study women had a mean age of 61 years and a mean vaginal parity of 3.3 children. The majority of the women were white (87%) and postmenopausal (86%). Thirty-seven women (20%) had stage 4 pelvic organ prolapse, 88 women (49%) had stage 3, and 55 women (30%) had

Comment

Recurrent pelvic organ prolapse has been described as a “gynecologic tragedy” in which “the patient deserves empathy and understanding and above all a very sophisticated reevaluation by the best and most experienced operator available.”6 Certainly, no pelvic surgeon would disagree with this assessment. This study challenges the current practice of stratifying preoperative evaluation of pelvic organ prolapse and limiting comprehensive evaluation to those patients with recurrent pelvic organ

References (6)

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