Pelvic organ prolapse after subtotal and total hysterectomy: a long‐term follow‐up of an open randomised controlled multicentre study

Abstract

Objective To analyse the development of pelvic organ prolapse (POP) after subtotal (SH) and total hysterectomy (TH) in the long-term, and to assess patient-reported symptoms regarding pelvic floor dysfunction (PFD).Design Long-term follow-up study of a randomised controlled multicentre study.Setting Seven hospitals and one private clinic in the south-east of Sweden.Population Of the 184 women who were eligible from the original trial, 151 (82%) responded to a postal questionnaire and 128 (70%) were clinically examined.Methods Postal questionnaire using the short-form version of the Pelvic Floor Distress Inventory (PFDI-20) and clinical examination using the POP-Q system. Multivariate analyses were used.Main outcome measures POP-Q measurements and symptoms of PFD.Results Follow-up time was a median of 11.3 years. Less than 3% had stage-3 prolapse. No significant difference was found in the presence of stage-2 or higher stage prolapse between the two hysterectomy groups (39% in SH versus 37% in TH; OR 1.28, 95% CI 0.59-2.80). Nor was there any significant difference in the quality-of-life measurement between the SH and TH groups [summary score PFDI-20: median 93 (range 60-201) versus 87 (range 60-186); Fisher's protected least significant difference post hoc test, P = 0.78 ). None of the symptoms of PFD revealed statistically significant differences between the hysterectomy groups.Conclusions This long-term follow-up study of PFD showed basically no significant differences in subjective or objective measurements of POP, or in specific pelvic floor quality-of-life aspects after SH and TH. However, because of the low statistical power the results are inconclusive. Larger trials, and probably also a longer follow-up period, are necessary.Keywords Hysterectomy, long-term follow-up, pelvic organ prolapse, pelvic organ prolapse-quantification, randomised trial.Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P. Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study BJOG 2013;120:1556-1565

Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up

“…Contrarily, Persson et al [12] found more women with anterior POP after SAH than after TAH (not statistically significant). Thakar et al [11] did not divide POP into compartments.…”

“…Regarding mode of hysterectomy several randomized clinical trials (RCTs) [10][11][12][13][14] have compared total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) regarding POP and UI; none have found differences between SAH and TAH.…”

Pelvic organ prolapse after subtotal and total hysterectomy: a long‐term follow‐up of an open randomised controlled multicentre study

“…We were pleased to learn that our paper 1 on the rate of subsequent surgery following endometrial ablation had been discussed at Drs Vo and Banerjee's Journal Club, and that its results will be used to help counsel women with heavy menstrual bleeding.…”

“…Sir, I read with interest the article by Persson et al 1 comparing the incidence of pelvic organ prolapse following total versus subtotal hysterectomy.…”

Authors' reply: Pelvic organ prolapse after subtotal and total hysterectomy: a long‐term follow‐up of an open randomised controlled multicentre study

“…1,2 The interpretation of the number of randomised control trials (RCTs) comparing abdominal subtotal hysterectomy (SH) and total hysterectomy (TH) should be seen not only in terms of the absolute number of RCTs but also in light of the time period during which the methods have been used. Both SH and TH have been used for more than a century but the first RCT presenting data on surgical outcomes was published in 2002.…”