Comparison of perioperative, long-term complications and recurrence rates after vaginal prolapse surgery by considering ICS POP-Q stage

Abstract

Pelvic organ prolapse (POP) is a bulge or protrusion into or through the vagina of pelvic organs and associated vaginal segments [1]. With the aging population, POP is an increasingly common condition seen in women with a lifetime prevalence of 30% to 50% [1,2]. Symptomatic urogenital prolapse has been shown to have significant negative impacts such as those relating to the lower urinary tract, fecal incontinence, back pain, pelvic pain, defecatory problems, and dyspareunia. Management options for women with symptomatic POP include observation, pelvic floor muscle training, mechanical support (pessaries), and surgery. A patient's perception of discomfort from POP and subsequent treatment will vary in relation to the stage of the POP and her ethnicity. Currently, many surgical approaches have been introduced to correct POP. The life time risk of undergoing surgery was estimated to be between 11% and 19%. However, none of these techniques is without risks for complications [2][3][4]. The prevalence of reopera-ORIGINAL ARTICLE Korean J Obstet Gynecol 2012;55(8) ObjectiveThe aim of this study was to report subjective and objective outcomes and to compare complication and recurrence rate in patients undergoing surgery for International Continence Society (ICS) stage 4 prolapse compared to ICS stage 2 or 3 prolapse. MethodsWe retrospectively reviewed the records of all patients having had surgical treatment for ICS Pelvic Organ Prolapse Quantification (POP-Q) stage 2-4 prolapse between January 2007 and December 2010 at the Yonsei University Severance Hospital. Only patients with ICS POP-Q stage 2-4 prolpase undergoing obliterative procedures or anti-incontinence surgery only were excluded. ResultsThree hundred ninety nine patients met inclusion criteria, including 23 with stage 2, 239 with stage 3 and 137 with stage 4 prolapse. The postoperative recurrence rate of preoperative stage IV was 2.4 times higher than that of stage III. There was a significantly higher incidence rates of perioperative and long-term complications, compared to women with other stage prolapse. The mean operative time was significantly greater in the stage 4 group compared to the stage 2, 3 group. ConclusionThe overall perioperative complication and recurrence rates in women undergoing surgery for pelvic organ prolapse are low. Women undergoing surgery for ICS POP-Q stage 4 prolapse were found to have a significantly greater blood loss and higher incidence rates of perioperative complications and recurrence, compared with women of other stage.