Risk Factors for Surgical Failure and Worsening Pelvic Floor Symptoms Within 5 Years After Vaginal Prolapse Repair

Overview

Journal Obstet Gynecol

Specialty Gynecology & Obstetrics

Date 2020 Oct 8

PMID 33030871

Citations 4

Authors

Sharon Jakus-Waldman

Linda Brubaker

John Eric Jelovsek

Joseph I Schaffer

David R Ellington

Donna Mazloomdoost

Ryan Whitworth

Marie G Gantz

Affiliations

Soon will be listed here.

Abstract

Objective: To assess independent risk factors for surgical failure and worsening pelvic floor symptoms within 5 years after vaginal prolapse surgery.

Methods: This secondary analysis includes OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) (n=374) and E-OPTIMAL (Extended) (n=285) trial participants. Surgical failure was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery or bothersome vaginal bulge. Worsening pelvic floor symptoms were defined as increases from baseline as large as the minimally important difference for subscale scores of the Pelvic Floor Distress Inventory: 11 for the Urinary Distress Inventory and Colorectal-Anal Distress Inventory and 34.3 for the Pelvic Organ Prolapse Distress Inventory. Outcomes were measured at 6 months then 1, 2, 3, 4, and 5 years. Chi-square and t test results from bivariate models and clinical relevance were used to inform final models.

Results: Baseline risk factors for surgical failure were Hispanic ethnicity (adjusted odds ratio [aOR] 1.92, 95% CI 1.17-3.15), perineal body (aOR 1.34, 95% CI 1.09-1.63), and pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 1.16, 95% CI 1.05-1.28). Risk factors for worsening of pelvic floor symptoms were pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 0.75, 95% CI 0.60-0.94) for worsening Pelvic Organ Prolapse Distress Inventory score, vaginal deliveries (aOR 1.26, 95% CI 1.10-1.44) and pretreatment Urinary Distress Inventory score (aOR 0.86, 95% CI 0.80-0.93) for worsening Urinary Distress Inventory score, and age (aOR 1.03, 95% CI 1.01-1.05) and pretreatment Colorectal-Anal Distress Inventory score (aOR 0.95, 95% CI 0.92-0.98) for worsening Colorectal-Anal Distress Inventory score.

Conclusions: Hispanic ethnicity, larger preoperative perineal body, and higher pretreatment Pelvic Organ Prolapse Distress Inventory scores were risk factors for surgical failure up to 5 years after vaginal prolapse repair. Participants with higher baseline Pelvic Floor Distress Inventory scores were less likely to worsen. Risk factors for worsening Urinary Distress Inventory and Colorectal-Anal Distress Inventory scores included more vaginal deliveries and increased age, respectively.

Clinical Trial Registration: NCT00597935, NCT01166373.

Citing Articles

Impact of preoperative pelvic floor muscle function on the success of surgical treatment of pelvic organ prolapse.

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PMID: 37819368 PMC: 10811015. DOI: 10.1007/s00192-023-05653-8.

Association between oxidative balance score and urinary incontinence in females: results from the national health and nutrition examination survey in 2005-2018.

Yuan Y, Tan W, Huang Y, Huang H, Li Y, Gou Y Int Urol Nephrol. 2023; 55(9):2145-2154.

PMID: 37314646 DOI: 10.1007/s11255-023-03665-3.

Association Between Enlarged Genital Hiatus and Composite Surgical Failure After Vaginal Hysterectomy With Uterosacral Ligament Suspension.

Bradley M, Sridhar A, Ferrante K, Andy U, Visco A, Florian-Rodriguez M Urogynecology (Phila). 2023; 29(5):479-488.

PMID: 36701331 PMC: 10132998. DOI: 10.1097/SPV.0000000000001309.

Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension.

Richter H, Sridhar A, Nager C, Komesu Y, Harvie H, Zyczynski H Am J Obstet Gynecol. 2022; 228(1):63.e1-63.e16.

PMID: 35931131 PMC: 9790026. DOI: 10.1016/j.ajog.2022.07.048.

References

Boyles S, Weber A, Meyn L . Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003; 188(1):108-15. DOI: 10.1067/mob.2003.101. View

Barber M, Kuchibhatla M, Pieper C, Bump R . Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001; 185(6):1388-95. DOI: 10.1067/mob.2001.118659. View

Dunivan G, Lyons K, Jeppson P, Ninivaggio C, Komesu Y, Alba F . Pelvic Organ Prolapse Stage and the Relationship to Genital Hiatus and Perineal Body Measurements. Female Pelvic Med Reconstr Surg. 2016; 22(6):497-500. PMC: 5111866. DOI: 10.1097/SPV.0000000000000323. View

Barber M, Brubaker L, Burgio K, Richter H, Nygaard I, Weidner A . Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014; 311(10):1023-34. PMC: 4083455. DOI: 10.1001/jama.2014.1719. View

Vergeldt T, Weemhoff M, IntHout J, Kluivers K . Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015; 26(11):1559-73. PMC: 4611001. DOI: 10.1007/s00192-015-2695-8. View

Jelovsek J, Chen Z, Markland A, Brubaker L, Dyer K, Meikle S . Minimum important differences for scales assessing symptom severity and quality of life in patients with fecal incontinence. Female Pelvic Med Reconstr Surg. 2014; 20(6):342-8. PMC: 4213305. DOI: 10.1097/SPV.0000000000000078. View

Bump R, Mattiasson A, Bo K, Brubaker L, DeLancey J, Klarskov P . The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1):10-7. DOI: 10.1016/s0002-9378(96)70243-0. View

Jelovsek J, Barber M, Brubaker L, Norton P, Gantz M, Richter H . Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical.... JAMA. 2018; 319(15):1554-1565. PMC: 5933329. DOI: 10.1001/jama.2018.2827. View

Suskind A, Jin C, Walter L, Finlayson E . Frailty and the Role of Obliterative versus Reconstructive Surgery for Pelvic Organ Prolapse: A National Study. J Urol. 2016; 197(6):1502-1506. PMC: 5472344. DOI: 10.1016/j.juro.2016.12.001. View

10.

Sung V, Borello-France D, Newman D, Richter H, Lukacz E, Moalli P . Effect of Behavioral and Pelvic Floor Muscle Therapy Combined With Surgery vs Surgery Alone on Incontinence Symptoms Among Women With Mixed Urinary Incontinence: The ESTEEM Randomized Clinical Trial. JAMA. 2019; 322(11):1066-1076. PMC: 6749544. DOI: 10.1001/jama.2019.12467. View

11.

Barber M, Walters M, Cundiff G . Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse. Am J Obstet Gynecol. 2006; 194(5):1492-8. DOI: 10.1016/j.ajog.2006.01.076. View

12.

Shull B, Bachofen C, Coates K, Kuehl T . A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000; 183(6):1365-73; discussion 1373-4. DOI: 10.1067/mob.2000.110910. View

13.

Handa V, Blomquist J, Knoepp L, Hoskey K, McDermott K, Munoz A . Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011; 118(4):777-84. PMC: 3178744. DOI: 10.1097/AOG.0b013e3182267f2f. View

14.

Morley G, DeLancey J . Sacrospinous ligament fixation for eversion of the vagina. Am J Obstet Gynecol. 1988; 158(4):872-81. DOI: 10.1016/0002-9378(88)90088-9. View

15.

Olsen A, Smith V, Bergstrom J, Colling J, Clark A . Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89(4):501-6. DOI: 10.1016/S0029-7844(97)00058-6. View

16.

Vaughan M, Siddiqui N, Newcomb L, Weidner A, Kawasaki A, Visco A . Surgical Alteration of Genital Hiatus Size and Anatomic Failure After Vaginal Vault Suspension. Obstet Gynecol. 2018; 131(6):1137-1144. DOI: 10.1097/AOG.0000000000002593. View

17.

Sutkin G, Zyczynski H, Sridhar A, Jelovsek J, Rardin C, Mazloomdoost D . Association between adjuvant posterior repair and success of native tissue apical suspension. Am J Obstet Gynecol. 2019; 222(2):161.e1-161.e8. PMC: 6995410. DOI: 10.1016/j.ajog.2019.08.024. View

18.

Brown J, Waetjen L, Subak L, Thom D, Van Den Eeden S, Vittinghoff E . Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol. 2002; 186(4):712-6. DOI: 10.1067/mob.2002.121897. View

19.

Barber M, Spino C, Janz N, Brubaker L, Nygaard I, Nager C . The minimum important differences for the urinary scales of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. Am J Obstet Gynecol. 2009; 200(5):580.e1-7. PMC: 2680021. DOI: 10.1016/j.ajog.2009.02.007. View

20.

MacLennan A, Taylor A, Wilson D, Wilson D . The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG. 2001; 107(12):1460-70. DOI: 10.1111/j.1471-0528.2000.tb11669.x. View