NEUROLOGY & FEMALE UROLOGY

Identification of risk factors for genital prolapse recurrence
Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, Antsaklis A, Milani R
Department of Obstetrics & Gynecology, Insubria University, Varese, Italy
Neurourol Urodyn. 2009; 28: 301-4

• Aims: To assess the relationship between prolapse recurrence and some risk factors in a group of women submitted to reconstructive pelvic surgery.
• Methods: Women referred to our Urogynaecological Units complaining of prolapse symptoms were prospectively included. We excluded women who were affected by apical vaginal prolapse > stage I after a previous hysterectomy. All women had pelvic surgery with traditional techniques without using grafts. Each woman was reassessed at 1, 6, and 12 months and then yearly postoperatively. We defined as prolapse recurrence a vaginal descent > or = II stage involving the operated compartments.
• Results: A total of 360 consecutive women were recruited and submitted to vaginal reconstructive pelvic surgery. At a mean follow-up of 26 months, 36 women (10%) had a recurrent prolapse. A preoperative vaginal descent > or = III stage was the only significant risk factor for recurrence (P = 0.02, OR 2.4, 1.1-5.1 95% CI).
• Conclusions: Women with prolapse > or = III stage had a significant higher risk of developing prolapse recurrence after surgical repair without grafts.
  
  
• Editorial Comment
  The authors review their population of females who underwent reconstructive vaginal surgery for pelvic prolapse. They excluded patients who had already had prolapse surgery or who had > stage II vaginal prolapse after previous hysterectomy. None of their patients had graft utilized in the reconstructive repair or had a synchronous concomitant anti-incontinence operation. The authors found that the only truly significant risk factor for recurrence of pelvic prolapse in their study was preoperative vaginal prolapse = stage III.
  An interesting study in that it treats a relatively pure population of patients who were treated for prolapse that had no previous anti-prolapse procedure performed, did not utilize any graft as part of the repair and did not have a synchronous anti-incontinence operation performed at the time of the surgery. The authors do self identify one of the weaknesses of this study in that they define recurrent prolapse as > stage II in the same operating vaginal compartment thus ignoring any potential vaginal vector shifts causing a production of prolapse in a separate compartment. That being said, I found it to be an excellent article of reference, which reviews classic pelvic floor reconstructions without potential complicating factors of graft material or concomitant anti-incontinence operations. Though current reports are highlighting the downside of graft materials, the authors wisely point out that the use of graft in > stage III prolapse may be rewarding in view of the potential recurrence rates of same.

Dr. Steven P. Petrou
Professor of Urology, Associate Dean
Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu