Abstract：
OBJECTIVE: Hysterectomy may be a risk factor for pelvic organ prolapse (POP). We assessed the risk of recurrent POP (operations and visits) after hysterectomy among women with previous POP. We also studied patient and operation related risk factors for POP recurrence.
METHODS: This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios.
RESULTS: Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits.
CONCLUSIONS: Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction.
METHODS: This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios.
RESULTS: Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits.
CONCLUSIONS: Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction.
摘要：
目的：子宫切除术可能是盆腔器官脱垂（POP）的危险因素。我们评估了先前患有POP的女性子宫切除术后复发性POP（手术和就诊）的风险。我们还研究了POP复发的患者和手术相关危险因素。
方法：这项回顾性队列研究包括1697名既往有POP诊断或子宫切除术时POP的妇女（FINHYST2006队列）。后续行动一直持续到2016年底。数据来自与该队列相关的芬兰国家护理登记册。将子宫切除术方法和其他人口统计学与脱垂诊断和/或手术的风险进行了比较。Cox回归模型用于识别风险比。
结果：子宫切除术后，共有280例(16.5%)女性因POP再次手术,359例(21.2%)因POP而门诊就诊.阴道穹窿脱垂修复是最常见的POP再手术（n=181，10.7%），其次是前壁修复（n=120，7.1％）。POP再手术的中位时间为3.7年。子宫切除术方法不影响再次手术或就诊。先前的剖宫产术和子宫切除术中的前路修补术与风险降低相关，而伴随的骶棘固定术和子宫脱垂作为主要指征导致前/穹窿脱垂再次手术的风险增加。伴随的后部修复减少了后部再手术和随访，但是子宫重量超过500g会导致后脱垂的风险增加五倍。居住状态与任何POP再操作和访问的风险增加有关。
结论：大约五分之一的患有POP的妇女在子宫切除术后进行POP再次手术或就诊。这些高比率与子宫切除术方法无关，但可能表明子宫切除术可能会加重先前的盆底功能障碍。
方法：这项回顾性队列研究包括1697名既往有POP诊断或子宫切除术时POP的妇女（FINHYST2006队列）。后续行动一直持续到2016年底。数据来自与该队列相关的芬兰国家护理登记册。将子宫切除术方法和其他人口统计学与脱垂诊断和/或手术的风险进行了比较。Cox回归模型用于识别风险比。
结果：子宫切除术后，共有280例(16.5%)女性因POP再次手术,359例(21.2%)因POP而门诊就诊.阴道穹窿脱垂修复是最常见的POP再手术（n=181，10.7%），其次是前壁修复（n=120，7.1％）。POP再手术的中位时间为3.7年。子宫切除术方法不影响再次手术或就诊。先前的剖宫产术和子宫切除术中的前路修补术与风险降低相关，而伴随的骶棘固定术和子宫脱垂作为主要指征导致前/穹窿脱垂再次手术的风险增加。伴随的后部修复减少了后部再手术和随访，但是子宫重量超过500g会导致后脱垂的风险增加五倍。居住状态与任何POP再操作和访问的风险增加有关。
结论：大约五分之一的患有POP的妇女在子宫切除术后进行POP再次手术或就诊。这些高比率与子宫切除术方法无关，但可能表明子宫切除术可能会加重先前的盆底功能障碍。
