Complications and reoperation after pelvic organ prolapse, impact of hysterectomy, surgical approach and surgeon experience
Abstract
Introduction and hypothesis The surgical treatment of pelvic organ prolapse (POP) is associated with specific complications. Our primary objective was to assess the recurrence requiring reoperation after prolapse surgery, and our secondary objectives were to assess the early complications and secondary surgery for urinary incontinence.Methods Retrospective study of a population-based cohort of all hospital or outpatient stays including POP surgery from 2008 to 2014, using the French nationwide discharge summary database. We calculated the rates of hospital readmission following surgery as well as the rates of reoperation for recurrent prolapse and subsequent procedures performed for urinary incontinence.Results A total of 310,938 patients had undergone surgery for POP. Two hundred fourteen (0.07%) patients died, and 0.45% were admitted to an intensive care unit; 4.4% of the patients underwent surgery for the recurrence of prolapse. Concomitant hysterectomy in the first surgery was associated with a significantly lower risk of POP surgery recurrence: (hazard ratio (HR) [95% confidence interval (CI)] = 0.51 [0.49; 0.53]). A total of 1386 (2.5%) patients were readmitted to the hospital for early (30-day) complications of prolapse surgery. The most frequent reasons for early readmission were local infection (32.8%), hemorrhage (21.4%) and pain (17.2%). Risk factors for complications were obesity, hospitals with low levels of activity and associated incontinence surgery; 4.6% of the patients required secondary surgery for urinary incontinence; obesity was a risk factor (HR [95% CI] = 1.12 [1.01; 1.24]), and the vaginal route was a protective factor (odds ratio = 1.86 for laparoscopy, 1.44 for laparotomy and 1.25 for multiple approaches).Conclusions POP surgery is associated with low rates of complication and recurrence. Complications occurred most commonly following combined surgeries for both prolapse and incontinence and in hospitals with low surgical volumes. Concomitant hysterectomy appears to be protective for the need for additional prolapse surgery, and the vaginal route leads to a lower frequency of secondary surgery for urinary incontinence.
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Population-based studies suggest a protective effect of hysterectomy on POP reoperation rates up to 7 years after index surgery.
“By contrast, population-based studies suggest a protective effect of hysterectomy on POP reoperation rates up to 7 years after index surgery.57,67,68”
From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [67]
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- Authors
- Mairesse, S., Chazard, E., Giraudet, G., Cosson, M., & Bartolo, S.
- Affiliations
- Université de Lille (FR)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Mairesse, Sybil
- Venue
- International Urogynecology Journal
- Published
- 2020-01-07
- Volume
- 31
- Issue
- 9
- Pages
- 1755-1761
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W2999453440
- Cited by
- 21
- References
- 24
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 3
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Ureteral procedures and complications
- Keywords
- pelvic organ prolapse, prolapse surgery, surgical complications, reoperation, prolapse recurrence, hysterectomy, urinary incontinence, surgical treatment of incontinence, hospital readmission, surgical volume, obesity, laparoscopy, laparotomy
- MeSH terms
- Female, Humans, Hysterectomy, Reoperation, Retrospective Studies, Gynecologic Surgical Procedures, Pelvic Organ Prolapse, Surgeons
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