Risk factors for pelvic organ prolapse in women after hysterectomy

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Abstract

Aim. To identify risk factors for the development of pelvic organ prolapse (POP) in women after hysterectomy.

Materials and methods. The study included 200 patients who presented for a scheduled follow-up examination 6 months after hysterectomy. The main group consisted of 100 patients who developed POP within 6 months after surgery, while the control group included patients without POP following the procedure. The diagnosis of POP was established based gynecological examination, and its severity was assessed using the international Pelvic Organ Prolapse Quantification (POP-Q) system. Inclusion criterion: hysterectomy performed six months prior to the study. Exclusion criteria: presence of oncopathology and refusal to participate (refusal to sign informed consent to participate in the study).

Results. According to POP-Q system, stage I POP was detected in 47 % of women, stage II in 34 %, and stage III in 19 %. Patients with POP were significantly more likely to be aged ≥54 years (55 % vs. 11 %, p <0.05), have a history of obstetric trauma (47 % vs. 12 %, p <0.05), and report regular heavy lifting (35 % vs. 9 %, p <0.05). Anthropometric parameters (height, weight, body mass index) and the prevalence of somatic pathology (diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, connective tissue dysplasia, chronic constipation) did not significantly differ between groups (p >0.05).

Conclusion. Age over 54 years, obstetric trauma, and a lifestyle associated with regular heavy lifting are key predictors of POP after hysterectomy. These factors exert a cumulative negative effect on the pelvic support structures, predisposing to functional insufficiency and organ descent. Identification of these risk factors during the preoperative evaluation enables the formation of high-risk groups, development of individualized preventive strategies, and optimization of surgical approaches to reduce the likelihood of recurrence.

About the authors

P. A. Koshulko

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

Author for correspondence.
Email: nikolconnik@gmail.com
ORCID iD: 0000-0003-2806-4017

Pavel Aleksandrovich Koshulko 

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

A. N. Shulga

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

D. M. Bregadze

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0007-2367-9430

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

V. S. Alenicheva

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0008-8740-2083

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

I. A. Arevdzhanyan

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0006-6230-0799

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

N. I. Sheptalova

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0005-7352-5232

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

D. D. Mukhametzyanova

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0003-8915-2704

600000 Владимир, Октябрьский проспект, 1

Russian Federation

A. S. Kamalova

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0009-4597-4144

600000 Владимир, Октябрьский проспект, 1

Russian Federation

E. M. Khabibullina

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0000-0002-5856-5333

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

A. V. Vasilyev

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

D. A. Shchetinina

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0004-4467-9200

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

M. B. Masolieva

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0007-6556-3620

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

G. S. Ibragimova

Vladimir branch of the Privolzhsky Research Medical University, Ministry of Health of Russia

ORCID iD: 0009-0002-7013-4277

1 Oktyabrsky Prospekt,  Vladimir 600000

Russian Federation

References

  1. Solovyeva E.A., Ivanov M.P., Petrova S.I. Risk factors for pelvic organ prolapse in women after hysterectomy: a cross-sectional study. Gynecology 2022;24(4):302–5. (In Russ.). doi: 10.26442/20795696.2022.4.201722
  2. Dällenbach P., Kaelin-Gambirasio I., Dubuisson J.-B., Boulvain M. Risk factors for pelvic organ prolapse repair after hysterectomy: case-control study. Am J Obstet Gynecol 2007;197(6):629.e1–9. doi: 10.1097/01.AOG.0000278567.37925.4e
  3. Husby K., Gradel K., Klarskov N. Pelvic organ prolapse following hysterectomy on benign indication: a nationwide, nulliparous cohort study. Am J Obstet Gynecol 2022;226(3):386.e1–9. doi: 10.1016/j.ajog.2021.10.021
  4. Höier Aagesen A., Klarskov N., Oren Gradel K., Ruben Husby K. Hysterectomy on benign indication and risk of pelvic organ prolapse surgery: a national matched cohort study. Acta Obstet Gynecol Scand 2023;102(6):774–81. doi: 10.1111/aogs.14561
  5. Yuk J.-S. Risk of pelvic organ prolapse after hysterectomy for benign conditions: a nationwide cohort study. Maturitas 2024;189:108090. doi: 10.1016/j.maturitas.2024.108090
  6. Forsgren C., Lundholm C., Johansson A. et al. Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery. Int Urogynecol J 2012;23(1):43–8. doi: 10.1007/s00192-011-1523-z

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