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Risk factors for pelvic organ prolapse recurrence following colpocleisis: A meta-analysis
Chen Nahshon1,2, Debjyoti Karmakar3, Yoram Abramov1,2
1Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel.
Background:
Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results.
Objective:
To investigate risk factors for POP recurrence following colpocleisis.
Search Strategy:
MEDLINE, PUBMED, Embase, Web of Science, and Cochrane databases were systematically searched.
Selection Criteria:
Experimental and non-experimental studies investigating POP recurrence following colpocleisis.
Data Collection And Analysis:
We assessed the association between preoperative and postoperative physical examination findings, demographics and medical history, and the risk of recurrence following colpocleisis.
Main Results:
A total of 954 studies were identified, of which five studies comprising 2978 patients were eligible for analysis. Both preoperative and postoperative genital hiatus length were significantly longer in the recurrence group (mean difference [MD] 0.48, 95% confidence interval [CI] 0.01-0.94, P = 0.04, I2 = 0% and MD 1.15, 95% CI 0.50-1.81, P = 0.005, I2 = 0%; respectively). Preoperative total vaginal length (TVL) did not differ between groups (MD 0.05, 95% CI -0.40 to 0.50, P = 0.83, I2 = 6%), postoperative TVL was found significantly longer in the recurrence group (MD 0.07, 95% CI -0.03 to 1.38, P = 0.04, I2 = 68%). Both preoperative and postoperative perineal body did not differ between groups. Women with a previous POP surgery were more likely to experience recurrence following colpocleisis (relative risk 2.09, 95% CI 1.18-3.69, P = 0.01, I2 = 0%). Patient's age and previous hysterectomy did not affect recurrence rates.
Conclusion:
Wider preoperative and postoperative genital hiatus as well as longer post-operative TVL and previous POP surgery were associated with a higher risk for recurrence following colpocleisis, highlighting the importance of appropriate patient selection and surgical technique in minimizing this risk.
