Introduction and Hypothesis: This follow-up study evaluates long-term subjective and objective outcome of native tissue anterior vaginal wall repair using local anesthesia. Methods: 72 women were operated. At 10-year follow-up anatomical results were evaluated by clinical examination. Furthermore, the women filled in a validated symptom and quality of life questionnaire. Results: Forty women (56%) completed the 10-year follow-up. Eighteen women (25%) had died within the ten-year follow-up period and fourteen women (19%) were lost to follow-up. Six (15%) of the women who came for follow-up had been reoperated for anterior vaginal wall prolapse within the 10-year follow-up period and were analysed as a separate group. Of the 40 women who came for the 10-year clinical examination none had stage 0 pelvic organ prolapse. Twenty (50%) women had stage 1, whereas, 13 (32%) had stage 2 and 1 (3%) had stage 3 pelvic organ prolapse. Ten years after surgery, 28 women (70%) had no bulge symptoms. Six (15%) of the women experienced bulge symptoms at the time of follow-up. Ten years postoperatively, 30 (75%) of the women in an overall quality of life assessment considered their condition improved after surgery. Conclusion: At 10-year follow-up 70% of women were relieved from their bulge symptoms and 75% still considered themselves better or much better than before the operation. However, 15% of women had been reoperated and 15% still experienced bulge symptoms.
POP is a prevalent condition in women with an approximately 12% lifetime risk of undergoing an operation for pelvic organ prolapse or incontinence [
Previous studies often report solely on anatomical operative results, whereas subjective results are sparsely reported. Furthermore, only few studies have described the long-term anatomical and subjective results following anterior vaginal wall repair.
The primary objective of the present study is to evaluate long-term results of anterior vaginal wall repair by investigating rate of reoperation, anatomical recurrence and subjective symptoms 10 years after primary surgery.
This study is a ten-year follow-up study.
From January 1998 until November 2000, 72 consecutive women were operated with primary anterior vaginal wall repair using local anesthesia at Aarhus University Hospital Denmark . Since this study is considered a “quality control” study, further approval by the national ethical committee is not needed in accordance to the Danish Law on medical research. None of the women had been operated in the anterior compartment before. Preoperatively, all women had moderate to severe bulge and or dragging symptoms, and objective findings of anterior vaginal wall prolapse, defined and staged according to the International Continence Society (ICS) quantification system as stage 2 or more [
The operations were performed using local anesthesia. The regime has previously been reported [
The anterior vaginal wall repair was made by opening the vaginal mucosa in the midline from the cervix/ vaginal top to 1.5 cm from the external opening of the urethra. Defects or attenuation of the pubocervical fascia were repaired by duplication of the fascia with a continuous suture (Ethicon, Vicryl® 2-0). Vaginal wall mucosa was trimmed and closed with a running suture (Ethicon, Vicryl® 2-0). After the operation the vagina was packed for two hours. None of the patients had an indwelling bladder catheter during the operation. Sixteen months (range 3 - 35 month) after the operation the patients had a telephone interview on subjective symptoms. The women who reported symptoms were invited to an examination. The questionnaire used, at the telephone interview were similar to the questionnaire used at the 10-year follow-up.
At 10-year follow-up the women were offered clinical examination. Anatomical outcome was evaluated and graded using the ICS quantification scale [
The women, who had been reoperated for anterior vaginal wall prolapse within the 10-year follow-up period, were considered treatment failures. Therefore, their objective and subjective status at follow-up are not reported. but presented separately as failures (
72 women who were operated from January 1998 until November 2000, 40 (56%) women attended the 10-year follow-up. Thus, 18 (25%) women had died within the ten-year follow-up period and 14 (19%) women did not attend follow-up (
At the time of the surgery the median age was 67 (range 37 - 86) years, the median body mass index was 26 (range 19 - 36), and 84% of the women were postmenopausal. Postoperatively, 24 (33.3%) women went home on the day of the operation. Forty-two (58.3%) women were admitted to the stationary ward for one day and six (8.3%) women stayed at the hospital for 2 days because of postoperative complications. Two had postoperative
bleeding and were reoperated. Two women had urinary retention. Two had hematoma and one of these was evacuated.
Before the operation, 29 (72%) had stage two pelvic organ prolaps, and 11 (28%) had stage three prolapse.
At the 10-year clinical examination none of the women had stage 0 POP. Twenty women (50%) had stage 1, whereas, 13 (32%) had stage 2 and one (3%) had stage 3 POP (
Preoperatively, all the women reported moderate to severe bulge symptoms.
All of the 40 women who came for 10-year follow-up also had had a telephone interview 16 month (range 3 - 35 month) after the operation, 34 (85%) women reported no bulge symptoms at the telephone interview whereas six (15%) reported bulge symptoms. None of the women received further treatment at the time of the interview.
10 years after surgery, 28 (70%) women in Pelvic Floor Distress Inventory (PFDI-20) reported no bulge symptoms. Six (15%) of the women had bulge symptoms at the time of follow-up (5% somewhat, 5% moderate 5% quite a bit). Six (15%) of the women had been reoperated (
Amongst the six women reporting bulge symptoms at 10-year follow-up, three women had stage 2 prolapse and three women had stage 1 prolapse on examination.
10 years postoperatively, 30 (75%) of the women in an overall quality of life assessment (PGI I) considered their condition improved after surgery. Twelve women considered themselves very much improved, 14 women much improved and 5 women minimally improved. 3 of the women felt that there was no change in QoL and 1 women considered herself minimally worsened. None of the women considered themselves much worse or very much worse.
There has over the years been a demand for more long-term follow-up data on POP surgery. In the present study we report long-term data on not only reoperation rate, but also on anatomical and subjective outcomes.
This study demonstrates that at 10-year follow-up 70% of women were relieved from their bulge symptoms by a low risk operation performed using local anesthesia. However, 15% of the women had been reoperated within the follow-up period, and 15% still experienced bulge symptoms. Thus, treatment failure was found in 30% of the women operated (15% reoperated + 15% still having bulge symptoms) 10 years after the operation.
A great challenge of such long-term follow-up is to retrieve representative number of women of the initial cohort for the clinical evaluation. Fifty four (75%) of the initial cohort were potentially available for follow-up. Of these 40 (74%) participated in the 10-year follow-up. This means that the percentage lost to follow-up was 26%, which we feel is acceptable in this long-term evaluation.
The long-term follow-up in this present study, allow us to make analysis based on long-term observations. Reports on anterior vaginal wall repair and recurrence are often based on short-term follow-up. Several studies emphasize that this might be a problem [
In this survey we report on both anatomic and subjective results. This gives the opportunity to discuss whether there is discordance between the surgical goals determined by the POP classification and the goals of the patient.
Recently more literature has discussed this issue. An operation for anterior vaginal wall prolapse has been defined as an anatomical success, if the women postoperatively have POP 1 or less determined by the ICS POP classification [
Our data show, that 50% had an anatomical classified successful operation status with POP stage 1. However 70% were relived from their bulge symptoms. Thus, 20% would have been classified unsuccessful in the classical anatomical term even though they were satisfied with the result. In the present study we found the reoperation rate for anterior wall prolapsed to be 15%. This recurrence-rate is similar to what have been reported in other studies. A prospective cohort analysis of 374 women who underwent surgery for POP or incontinence found the 10-year reoperation rate to be 17% [
This follow-up after operation for anterior vaginal wall prolaps found that 70% of the women were still relieved from their bulge symptoms by a low risk operation, using local anesthesia 10 years after the operation. However 15% of the women were reoperated and 15% still experienced bulge symptoms.
The authors report no conflicts of interest.
75% of the women in this long-term follow-up study still considered their condition improved 10 years after anterior colporrhaphy. 15% had been reoperated during follow-up.
Cecilie HestbechLundorff,MarianneGlavind-Kristensen,Susanne MaigaardAxelsen,Karl MøllerBek,SusanneGreisen, (2015) Subjective and Objective Results of Native Anterior Vaginal Wall Repair in Local Anesthesia: A 10-Year Follow-Up. Open Journal of Obstetrics and Gynecology,05,762-767. doi: 10.4236/ojog.2015.513107