Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy

Abstract

Our objective was to estimate the incidence and identify the risk factors for vaginal vault prolapse repair after hysterectomy. We conducted a case control study among 6,214 women who underwent hysterectomy from 1982 to 2002. Cases (n=32) were women who required vaginal vault suspension following the hysterectomy through December 2005. Controls (n=236) were women, randomly selected from the same cohort, who did not require pelvic organ prolapse surgery. The incidence of vaginal vault prolapse repair was 0.36 per 1,000 womenyears. The cumulative incidence was 0.5%. Risk factors included preoperative prolapse (odds ratio (OR) 6.6; 95% confidence interval (CI) 1.5-28.4) and sexual activity (OR 1.3; 95% CI 1.0-1.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (OR 0.9; 95% CI 0.5-1.8).Vaginal vault prolapse repair after hysterectomy is an infrequent event and is due to preexisting weakness of pelvic tissues.

Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women’s views on a new technique

“…Studies of prolapse after vaginal hysterectomy indicate a low rate for this complication, which occurs when pelvic floor tissues are weak preoperatively [18]. After transvaginal NOTES, because the colpotomy is performed in the posterior fornix, the uterine suspensory ligaments (apical support) remain unaffected by the procedure, so the incidence of prolapse (hernia) likely is low.…”

Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study

“…However, hysterectomy removes a healthy, albeit poorly supported organ. It fails to tackle pathological connective tissue weakness, primarily the uterosacral and cardinal ligaments, and this contributes to the subsequent high apical prolapse rates seen with this operation [3][4][5].…”

Long-Term Results of Laparoscopic Colposuspension with Bilateral Round-Infundibulopelvic Ligaments after Hysterectomy for Uterovaginal Prolapse

“…Recent studies reported that vaginal hysterectomy is not a risk factor for pelvic organ prolapse repair or vaginal vault prolapse repair when preoperative prolapse is taken into account. Grade 2 or more preoperative prolapse was significantly associated with reoperation [13,14]. However, we preferred supracervical or subtotal hysterectomy to total hysterectomy.…”