Tasa de recidivas e impacto sobre la continencia urinaria en pacientes intervenidas de prolapso de órganos pélvicos en el Hospital Clínico Universitario Virgen de la Arrixaca

Abstract

Objetive: to analyse the results of pelvic organ prolapse surgery. Methods: we recruited 273 patients who underwent pelvic organ prolapse surgery in Hospital Universitario Virgen de la Arrixaca between 2013 and 2015. All patients underwent a vaginal hysterectomy. Furthermore we performed 11 anterior colpoplasties, 1 posterior colpoplasty, 256 patients underwent both colpoplasties and in 49 cases prolapse surgery was associated with the placement of tension-free vaginal tape. Follow-up was carried out between January 2013 and January 2017. Two postoperative reviews were performed in most cases. During the anamnesis, pacients were asked about the presence of vaginal bulge, urinary urgency or urinary incontinence, in which case the quality of life (ICIQ-SF) and the severity of incontinence (Sanvik) questionnaires were performed. For prolapse staging, the Baden-Walker System Classification was used. An objective assessment of urinary incontinence was performed by means of 300cc saline bladder stress test. Surgical failure was defined as Baden-Walker grade 2 or higher. Risk factors of prolapse recurrence after reconstructive surgery were analysed. Results: A 4% reintervention rate was found. As to the objective evaluation, surgical failure in one or more compartments was found in 21,8% of cases with the following distribution: 4,3% apical, 10,5% anterior and 7% posterior. Urinary incontinence was found in 11,4% of patients, distributed in 7,9% stress incontinence, 2,2% urgency incontinence, 0,9% mixed incontinence and 0,4% occult stress incontinence. De novo stress urinary incontinence was found in 3,8% cases and de novo urgency incontinence in 5,3% cases. In the subjective assesment, 54,6% of patients reported they were symptom-free. Absence of sensation of prolapse was reported in 88,2% of the interviewed patients and urinary urgency in 13,5% of cases. Urgency incontinence was reported in 12,7% cases, stress incontinence in 10,9% and mixed urinary incontinence in 7,8% cases. Preoperative anterior vaginal prolpase grade 3 or higher was identified as risk factor for failure in surgery of uterine prolapse and cystocele (OR 15,76, p=0,012 y OR 3,93, p=0,025 respectively), whereas the history of fetal macrosomia was a risk factor for failure in rectocele surgery (OR 5,95, p=0,003). Conclusions: good surgical results were obtained in our sample when compared with other series, reaching low reintervention rates. We found poor correlation between the symptoms refered by patients and the results in objetive examinations . Preoperative anterior vaginal prolpase and a history of a fetal macrosomia were found to be significant risk factors for prolapse recurrence.