Document Detail


Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation.
MedLine Citation:
PMID:  12752079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To identify risk factors in recurrence and to evaluate anatomic and functional results of vaginal sacrospinous ligament fixation and pelvic floor reconstruction for genital prolapse. METHODS: One hundred and thirty-eight women underwent surgery for uterovaginal or vault prolapse. Follow-up data were available for 122 cases; 83% were examined and others were interviewed by telephone. The median (range) follow-up was 24 (1-141) months. Cox regression was used to identify risk factors associated with recurrence; uni- and multivariate regression was used to identify risk factors underlying postoperative infections because infections were found to be a risk factor of recurrence. Recurrence-free survival was estimated using the Kaplan-Meier method. RESULTS: Seven (5%) patients suffered severe cardiopulmonary complications including one postoperative death due to a pulmonary embolism. Twenty-six (21%) patients suffered a recurrence, 14 with cystocele. Ten patients with recurrence were symptomatic and six underwent a re-operation. The Cox regression model showed that vaginal cuff infection raised the odds ratio (OR) for recurrence to 6.13 [confidence interval (CI) 1.80-20.83] and urinary tract infection to 3.65 (CI 1.40-9.47). In both uni- and multivariate analysis, lack of intravenous antibiotic prophylaxis, age less than 73 years and vaginal ulcerations were statistically significant risk factors for postoperative infection. Eleven (33%) out of 33 sexually active women reported improvement and three (9%) complained of dyspareunia. CONCLUSIONS: Transvaginal sacrospinous ligament fixation with pelvic floor repair is an effective means of correcting both vault prolapse and uterine procidentia. Women who wish to preserve coital function will also benefit from this operation. Postoperative infection is an independent and most important individual risk factor underlying recurrence. Prophylactic antibiotics seem to be effective in reducing the rate of postoperative infections.
Authors:
Kari Nieminen; Heini Huhtala; Pentti K Heinonen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  82     ISSN:  0001-6349     ISO Abbreviation:  Acta Obstet Gynecol Scand     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-19     Completed Date:  2003-07-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  Unknown    
Other Details:
Languages:  eng     Pagination:  471-8     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School and School of Public Health, University of Tampere, Tampere, Finland. kn37975@uta.fi
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Aged
Aged, 80 and over
Antibiotic Prophylaxis
Broad Ligament / surgery*
Female
Finland
Gynecologic Surgical Procedures / adverse effects,  methods
Humans
Middle Aged
Multivariate Analysis
Pelvic Floor / surgery
Proportional Hazards Models
Pulmonary Embolism / etiology
Quality of Life
Recurrence
Retrospective Studies
Risk Factors
Sacrococcygeal Region / physiopathology,  surgery*
Time Factors
Urinary Tract Infections / etiology
Uterine Prolapse / physiopathology,  surgery*
Vagina / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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