An evaluation of the effect of operation type on postoperative outcomes in patients operated for pelvic organ prolapse

Aim: The prevalence and incidence of POP varies across the populations studied; however, approximately 50% of women over 50 years of age have at least one of the symptoms of POP. According to studies, approximately 10% of women undergo at least one operation for prolapse in their lifetime, and approximately 30% of patients who undergo an operation need to have operation again.. In this study, we aimed to evaluate the postoperative outcomes of patients who underwent surgery for pelvic organ prolapse, based on the type of operation performed. Materials and Methods: The medical records of patients operated for pelvic organ prolapse in the Gynecology and Obstetrics Clinic of Balıkesir University Health Practice and Research Hospital between January 2016 and January 2023 were retrospectively analyzed. Demographic characteristics of the patients and information about the operation were extracted from hospital records. A total of 97 female patients aged between35-80 years, non-pregnant, and without comorbidities were included in the study. The patients were divided into 3 groups as follows: patients who underwent abdominal surgery such as sacrocolpopexy, lateral suspension, pectopexy due to prolapse (Group 1), patients who underwent vaginal hysterectomy + cystorectocele+ sacrospinous ligament fixation (Group 2) and patients who underwent vaginal hysterectomy + cystorectocele operation (Control group). Preoperative and postoperative complaints of the patients were evaluated. Findings: In this study, 96.9% of the patients operated for pelvic organ prolapse and included in the study had prolapse complaints, 7.2% had constipation, 5.2% had dyspareunia, 16.5% had incontinence, and 29.9% had pain complaints before the operation.. In the group that underwent abdominal surgery, 3 patients (14.3%) had constipation preoperatively, whereas no patients had persistent constipation postoperatively. In Group 2 (Vaginal hysterectomy+CAP+SSLP), 4 patients (16%) had constipation preoperatively, 2 patients (8%) continued to have constipation postoperatively, and 2 patients had no constipation. In the control group, there were no patients with preoperative constipation. While the number of patients with pain complaints before the operation was 7 (33.3%) in the abdominal group, pain complaints of 5 patients disappeared after the operation, and pain complaints of 2 patients (9.5%) persisted. In Group 2 (vaginal hysterectomy+CAP+SSLP), while the number of patients with pain complaints before the operation was 5 (20%), 1 patient (4%) had pain complaints after the operation and 4 patients had no pain complaints. In the control group (VAH+CAP), 17 patients (33.3%) had complaints of pain before the operation, while only 1 patient (2%) continued to have pain after the operation, and 16 patients had no pain complaints. The decrease in postoperative pain complaints compared to the preoperative period was statistically significant only in the control group. In the group of patients who underwent abdominal surgery, 3 patients (14.3%) had dyspareunia preoperatively, 2 patients (9.5%) continued to have dyspareunia postoperatively, and 1 patient had no complaints. In Group 2 (VAH+CAP+SSLP), there was no patient with preoperative dyspareunia, and there was no patient with postoperative dyspareunia. In the control group (VAH+CAP), dyspareunia was present in 2 patients (3.9%) preoperatively, while dyspareunia persisted in 1 patient (2%) postoperatively, and the other patient had no complaint. In postoperative follow-up, recurrence rates were 28.6% in the abdominal surgery group, 8% in Group 2, and 2% in the control group, and more recurrences were observed in the abdominal surgery group compared to the control group. Conclusion: Our study shows that the abdominal approach is associated with more recurrence than the vaginal approach in prolapse surgery. Keywords: Pelvic Organ Prolapse, Dyspareunia, Constipation, Urinary Incontinence