Risk factors for surgical failure and worsening pelvic floor symptoms within 5 years after vaginal prolapse repair
Open accessAbstract
OBJECTIVE: To assess independent risk factors for surgical failure and worsening pelvic floor symptoms within 5 years after vaginal prolapse surgery. METHODS: This secondary analysis includes OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) (n=374) and E-OPTIMAL (Extended) (n=285) trial participants. Surgical failure was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery or bothersome vaginal bulge. Worsening pelvic floor symptoms were defined as increases from baseline as large as the minimally important difference for subscale scores of the Pelvic Floor Distress Inventory: 11 for the Urinary Distress Inventory and Colorectal-Anal Distress Inventory and 34.3 for the Pelvic Organ Prolapse Distress Inventory. Outcomes were measured at 6 months then 1, 2, 3, 4, and 5 years. Chi-square and t test results from bivariate models and clinical relevance were used to inform final models. RESULTS: Baseline risk factors for surgical failure were Hispanic ethnicity (adjusted odds ratio [aOR] 1.92, 95% CI 1.17–3.15), perineal body (aOR 1.34, 95% CI 1.09–1.63), and pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 1.16, 95% CI 1.05–1.28). Risk factors for worsening of pelvic floor symptoms were pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 0.75, 95% CI 0.60–0.94) for worsening Pelvic Organ Prolapse Distress Inventory score, vaginal deliveries (aOR 1.26, 95% CI 1.10–1.44) and pretreatment Urinary Distress Inventory score (aOR 0.86, 95% CI 0.80–0.93) for worsening Urinary Distress Inventory score, and age (aOR 1.03, 95% CI 1.01–1.05) and pretreatment Colorectal-Anal Distress Inventory score (aOR 0.95, 95% CI 0.92–0.98) for worsening Colorectal-Anal Distress Inventory score. CONCLUSIONS: Hispanic ethnicity, larger preoperative perineal body, and higher pretreatment Pelvic Organ Prolapse Distress Inventory scores were risk factors for surgical failure up to 5 years after vaginal prolapse repair. Participants with higher baseline Pelvic Floor Distress Inventory scores were less likely to worsen. Risk factors for worsening Urinary Distress Inventory and Colorectal-Anal Distress Inventory scores included more vaginal deliveries and increased age, respectively. CLINICAL TRIAL REGISTRATION: NCT00597935, NCT01166373.
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Self-citation
- Authors
- Jakus-Waldman, S., Brubaker, L., Jelovsek, J. E., Schaffer, J. I., Ellington, D. R., Mazloomdoost, D., Whitworth, R., Gantz, M. G., & for the NICHD Pelvic Floor Disorders Network (PFDN)
- Affiliations
- National Institutes of Health (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2020-10-06
- Volume
- 136
- Issue
- 5
- Pages
- 933-941
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC7842362
- OpenAlex
- W3091803542
- Cited by
- 14
- References
- 30
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 2
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD041261, UG1HD041261, UG1HD069006, U10HD054214, U10HD069010, U10HD069006, U01HD069031, U10HD069013, U10HD041267, U10HD054241, UG1HD054214, UG1HD069010, UG1HD054241, U24HD069031, UG1HD041267, UG1HD069013)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- vaginal prolapse repair, surgical failure, pelvic floor symptoms, risk factors, pelvic organ prolapse, Hispanic origin, perineal body, urinary symptoms, vaginal delivery, OPTIMAL trial, pelvic floor muscle training
- MeSH terms
- Adult, Aged, Fecal Incontinence, Female, Humans, Middle Aged, Postoperative Complications, Postoperative Period, Quality of Life, Risk Factors, Severity of Illness Index, Gynecologic Surgical Procedures, Time Factors, Urinary Incontinence, Stress, Vagina, Vaginal Diseases, Odds Ratio, Randomized Controlled Trials as Topic, Treatment Failure, Disease Progression, Pelvic Organ Prolapse
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