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Long-Term Outcomes after Pelvic Organ Prolapse Repair in Young Women
Marine Lallemant1, Yasmine Clermont-Hama1, Géraldine Giraudet1
1Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France.
Insights
Pelvic Organ Prolapse (POP) repair in women under 40 showed higher recurrence with transvaginal mesh (VMS) and native tissue repair (NTR) compared to sacrohysteropexy. Sacrohysteropexy is recommended for young women to improve quality of life.
Area of Science:
- Urogynecology
- Pelvic Floor Disorders
- Surgical Outcomes
Background:
- Pelvic Organ Prolapse (POP) significantly impacts quality of life, particularly in young women.
- Long-term surgical outcomes for POP in women under 40 are less understood.
- Comparing different POP surgical techniques in this demographic is crucial.
Purpose of the Study:
- To evaluate and compare the long-term outcomes of different Pelvic Organ Prolapse (POP) repair methods in women under 40 years old.
- To identify the recurrence rates and complication profiles associated with sacrohysteropexy, vaginal native tissue repair (NTR), and transvaginal mesh surgery (VMS).
Main Methods:
- Retrospective chart review of 43 women under 40 who underwent POP repair (January 1997-December 2015).
- Patients were categorized into sacrohysteropexy, vaginal native tissue repair (NTR), and transvaginal mesh surgery (VMS) groups.
- Primary outcome: reoperation for symptomatic recurrent POP. Secondary outcomes: other complications.
Main Results:
- POP recurrence was highest in the VMS (87.5%) and NTR (50%) groups compared to sacrohysteropexy (7%).
- Overall reoperation rates were 7% for sacrohysteropexy, 62.5% for VMS, and 25% for NTR.
- Mesh exposure occurred in 4% of VMS patients; de novo stress urinary incontinence affected 29% of sacrohysteropexy and 12.5% of NTR patients.
Conclusions:
- Sacrohysteropexy demonstrates superior long-term outcomes with lower recurrence and reoperation rates in young women undergoing POP repair.
- Vaginal native tissue repair (NTR) and transvaginal mesh surgery (VMS) are associated with significantly higher rates of POP recurrence and complications.
- POP repair should be offered to young women to improve quality of life, with sacrohysteropexy or NTR recommended after thorough discussion of risks and benefits.
Abstract:
The aim of the study was to describe the long-term outcomes of Pelvis Organ Prolapse (POP) repair in women under 40 years old. A retrospective chart review of all POP repairs performed in women ≤40 years old between January 1997 and December 2015 in the Gynecologic Surgery Department of Lille University Hospital was performed. Inclusion criteria were all women ≤40 years old who underwent a POP repair with a stage ≥2 POP according to the Baden and Walker classification. The study population was separated into three groups: a sacrohysteropexy group, a vaginal native tissue repair (NTR) group, and a transvaginal mesh surgery (VMS) group. The primary outcome was reoperation procedures for a symptomatic recurrent POP. Secondary outcomes were other complications. During the study period, 43 women ≤ 40 years old who underwent a POP repair were included and separated into three groups: 28 patients (68%), 8 patients (19%), and 7 patients (16%) in the sacrohysteropexy, VMS, and NTR groups respectively. The mean followup time was 83 ± 52 months. POP recurrence, reoperated or not, was essentially diagnosed in the VMS group (87.5%) and the NTR group (50%). POP recurrence repairs were performed for nine patients (21%): 7%, 62.5%, and 25% in the sacrohysteropexy, VMS, and NTR groups, respectively. Global reoperation concerned 10 patients (23%) whatever the type of POP surgery, mainly patients from the VMS group (75%) and from the NTR group (25%). It occurred in only 7% of patients from the sacrohysteropexy group. Two patients (4%) presented a vaginal exposure of the mesh (in the VMS group). De novo stress urinary incontinence was encountered by nine patients (21%): 29% and 12.5% in the sacrohysteropexy and NTR groups, respectively. Despite the risk of recurrence, POP repair should be proposed to young women in order to restore their quality of life. Vaginal native tissue repair or sacrohysteropexy should be performed after explaining to women the advantages and disadvantages of each procedure.
