Efficacy and Safety of Vaginal Native Tissue Repair for Pelvic Organ Prolapse Across Frailty Levels

To evaluate 1-year symptomatic, anatomical, and perioperative outcomes after primary vaginal native tissue repair for pelvic organ prolapse across frailty levels in surgically selected women.

Retrospective cohort study of women who underwent primary pelvic organ prolapse surgery consisting of vaginal total hysterectomy, modified McCall culdoplasty, and anteroposterior colporrhaphy. Participants were stratified according to the Frailty Index (FI).

Single tertiary medical center.

A total of 706 women with complete 12-month follow-up were included and categorized into four groups: age <65 years (n = 214), FI score 0 (n = 283), FI score 1 to 2 (n = 173), and FI score ≥3 (n = 36).

All patients underwent standardized preoperative and 12-month postoperative assessments, including clinical evaluation, pelvic examination, and introital four-dimensional ultrasonography.

The primary outcomes were postoperative lump sensation (efficacy) and postoperative voiding difficulty (safety). Secondary outcomes included postoperative anatomical outcomes, adverse events, item 3 of the short Pelvic Floor Distress Inventory, and ultrasonographic parameters of voluntary pelvic floor muscle function. At 12 months, lump sensation (0.5%-2.8%) and voiding difficulty (0.4%-2.8%) were uncommon and comparable across FI groups. Frailty was not independently associated with postoperative lump sensation (odds ratio 1.06, 95% confidence interval 0.25-4.53) or postoperative voiding difficulty (odds ratio 2.03, 95% confidence interval 0.26-16.07).

Among functionally independent and carefully selected patients, 1-year outcomes after standardized vaginal native tissue repair were comparable across FI groups. Because the frail subgroup was small and highly selected, these findings should not be extrapolated to dependent or medically high-risk frail women or to long-term outcomes.