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Primary surgery of genital prolapse: a shift in treatment tradition.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, no 9, 1104-1108 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period.

METHODS: A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data.

RESULTS: The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001).

CONCLUSION: The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.

Place, publisher, year, edition, pages
Taylor & Francis , 2006. Vol. 85, no 9, 1104-1108 p.
Keyword [en]
Genital prolapse, pelvic floor dysfunction, pelvic surgery, posterior repair, retrospective study
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17399DOI: 10.1080/00016340500470168PubMedID: 16929416OAI: oai:DiVA.org:liu-17399DiVA: diva2:209019
Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2009-05-08Bibliographically approved
In thesis
1. Genital prolapse surgery: A study of methods, clinical outcome and impact of pelvic floor muscle function
Open this publication in new window or tab >>Genital prolapse surgery: A study of methods, clinical outcome and impact of pelvic floor muscle function
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: To evaluate whether a shift in the extent of genital prolapse surgery occurred between 1983 and 1993. If such a shift occurred, the need for subsequent prolapse surgery; the prevalence of symptoms of pelvic floor dysfunction (PFD) in women six years after vaginal prolapse surgery. And also to analyze predictive factors and the subjective and objective outcomes of prolapse surgery at long term follow up. To evaluate whether neurophysiologic findings of the pelvic floor muscles and anorectal manometry measurements respectively are associated with pre- and postoperative symptoms and the extent of prolapse.

Methods/material: A retrospective study of 542 consecutive patients, operated on for genital prolapse, with primary surgery during 1983 and 1993 in three Swedish hospitals was conducted. Data were obtained from the patient records and were analyzed with emphasis on demographic, clinical and surgical data. A postal questionnaire with validated questions concerning symptoms of PFD was in 1999 sent to women operated in 1993 for primary POP and no subsequent POP surgery.

A prospective study of 42 women with genital prolapse, stage 2-3, scheduled for vaginal prolapse surgery was carried out. Preoperatively the women were examined with anorectal manometry, pudendal nerve neurography and concentric needle electromyography of the pubococcygeus muscles and the external anal sphincter muscle. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated six years postoperatively.

Results: A shift from complete to selective repairs was seen between the two time periods, and posterior repair was often omitted in the latter period. The prevalence of subsequent prolapse surgery increased in the 1990s and the increase was more common in women with a selective repair than in those with complete repair. At long term, PFD-symptoms commonly occurred and were found to be associated with the extent of the prolapse surgery. Symptoms of prolapse and bowel emptying improved significantly after POP surgery in the prospective study. The cure rates of rectocele and apical descent were high, but low concerning cystocele. The results of the neurophysiologic investigations and anal sphincter pressures showed associations with the symptoms and the extent of the prolapse; the individual characteristics showed no discriminatory values.

Conclusion: The extent of the surgical prolapse procedures changed between the two study periods and the extent of subsequent surgery also was greater in the second period. Symptoms of PFD and recurrence of prolapse, especially of the anterior compartment, were frequently seen. Prolapse and bowel symptoms were associated with the function of pelvic floor muscles but neither the results of the neurophysiologic nor the anorectal manometry measurements of the pelvic floor muscles were found to predict anatomical or subjective outcomes of POP surgery. More knowledge is needed of the pathophysiology of PFD in order to develop better means of prevention and to optimize treatment of POP. Development of new methods for identifying all defects of the pelvic floor and surgical techniques for restitution is also warranted for improving outcome of surgical treatment of genital prolapse.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 96 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1103
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17417 (URN)978-91-7393-689-7 (ISBN)
Public defence
2009-03-27, Bohmanssonsalen, Universitetssjukhuset, Örebro, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2013-10-10Bibliographically approved

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Crafoord, KristinaSydsjö, AdamKjølhede, Preben

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