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Kuittinen T, Mentula M, Tulokas S, Brummer T, Jalkanen J, Tomas E, Mäkinen J, Sjöberg J, Härkki P, Rahkola-Soisalo P. Recurrent pelvic organ prolapse after hysterectomy; a 10-year national follow-up study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07615-x. [PMID: 38976021 DOI: 10.1007/s00404-024-07615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Hysterectomy may be a risk factor for pelvic organ prolapse (POP). We assessed the risk of recurrent POP (operations and visits) after hysterectomy among women with previous POP. We also studied patient and operation related risk factors for POP recurrence. METHODS This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios. RESULTS Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits. CONCLUSIONS Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction.
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Affiliation(s)
- Tea Kuittinen
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland.
| | - Maarit Mentula
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Sari Tulokas
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | | | | | - Eija Tomas
- University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Jari Sjöberg
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Päivi Härkki
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Päivi Rahkola-Soisalo
- Women's Clinic, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290, Helsinki, Finland
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Filippini M, Angioli R, Luvero D, Sammarini M, De Felice G, Latella S, de Góis Speck NM, Farinelli M, Martire FG, Gulino FA, Incognito GG, Capriglione S. The Utility of CO 2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery. J Pers Med 2023; 14:60. [PMID: 38248761 PMCID: PMC10817595 DOI: 10.3390/jpm14010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
This study aimed to examine the impact of fractional CO2 laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor (n = 11); and (2) women who had experienced spontaneous tears during vaginal delivery (n = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, p = 0.03; 6.5 vs. 3 after the second treatment, p = 0.01; 3 vs. 1 after the third treatment, p = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, p = 0.01; 8 vs. 4 after the second treatment, p = 0.02; 3 vs. 1 after the third treatment, p = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO2 laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, 00128 Rome, Italy; (R.A.); (D.L.)
| | - Daniela Luvero
- Department of Obstetrics and Gynecology, Campus Bio-Medico University, 00128 Rome, Italy; (R.A.); (D.L.)
| | - Margaret Sammarini
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Giovanna De Felice
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Silvia Latella
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Neila Maria de Góis Speck
- Gynecological Disease Prevention Nucleus (NUPREV), Department of Gynecology, Paulista Medical School (UNIFESP/EPM), Federal University of São Paulo, São Paulo 04023-062, Brazil;
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, Hospital State of Republic of San Marino, 47893 Borgo Maggiore, San Marino; (M.F.); (M.S.); (G.D.F.); (S.L.); (M.F.)
| | - Francesco Giuseppe Martire
- Gynecological Unit, Department of Surgical Sciences, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Ferdinando Antonio Gulino
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adults and Developmental Age, “G. Martino” University Hospital, 98122 Messina, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy;
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, “Santa Maria alla Gruccia” Hospital, 52025 Montevarchi, Italy;
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