Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study

Authors

  • P Persson,

    Corresponding author
    1. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
    • Correspondence: Dr P Persson, Department of Women's and Children's Health, Uppsala University, S-751 85, Uppsala, Sweden. Email par.persson@kbh.uu.se

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  • J Brynhildsen,

    1. Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences and Department of Obstetrics and Gynaecology, Linköping University, County Council of Östergötland, Linköping, Sweden
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  • P Kjølhede,

    1. Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences and Department of Obstetrics and Gynaecology, Linköping University, County Council of Östergötland, Linköping, Sweden
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  • and on behalf of the Hysterectomy Multicentre Study Group in South-East Sweden


Abstract

Objective

To analyse the development of pelvic organ prolapse (POP) after subtotal (SH) and total hysterectomy (TH) in the long-term, and to assess patient-reported symptoms regarding pelvic floor dysfunction (PFD).

Design

Long-term follow-up study of a randomised controlled multicentre study.

Setting

Seven hospitals and one private clinic in the south-east of Sweden.

Population

Of the 184 women who were eligible from the original trial, 151 (82%) responded to a postal questionnaire and 128 (70%) were clinically examined.

Methods

Postal questionnaire using the short-form version of the Pelvic Floor Distress Inventory (PFDI-20) and clinical examination using the POP-Q system. Multivariate analyses were used.

Main outcome measures

POP-Q measurements and symptoms of PFD.

Results

Follow-up time was a median of 11.3 years. Less than 3% had stage-3 prolapse. No significant difference was found in the presence of stage-2 or higher stage prolapse between the two hysterectomy groups (39% in SH versus 37% in TH; OR 1.28, 95% CI 0.59–2.80). Nor was there any significant difference in the quality-of-life measurement between the SH and TH groups [summary score PFDI-20: median 93 (range 60–201) versus 87 (range 60–186); Fisher's protected least significant difference post hoc test, = 0.78 ). None of the symptoms of PFD revealed statistically significant differences between the hysterectomy groups.

Conclusions

This long-term follow-up study of PFD showed basically no significant differences in subjective or objective measurements of POP, or in specific pelvic floor quality-of-life aspects after SH and TH. However, because of the low statistical power the results are inconclusive. Larger trials, and probably also a longer follow-up period, are necessary.

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