RISK FACTORS FOR PROLAPSERECURRENCE- SYSTEMATIC REVIEW AND META-ANALYSIS
T. FRIEDMAN, G. D. ESLICK, H.DIETZ;
Sydney Med. Sch. Nepean, Sydney, Australia.
Introduction: Female pelvicorgan prolapse (FPOP) is a common condition, that si associated withsignificant impairment of quality of life (1), with a lifetime riskfor surgery of 10-20% (2, 3). Prolapse surgery is known to have ahigh reoperation rate (30%). Little is known about the factorsassociated with surgical failure. It is plausible that factorsplaying a role in POP etiology may also be risk factors for POPrecurrence. There are several reviews/ systematic review available toevaluate risk factors for prolapse and prolapse recurrence. However,we have not been able to identify a recent meta-analysis on thisissue.
Objective: To perform a systemic review andquantitative meta-analysis in order to determine risk factors forrecurrence of prolapse after surgery.
Methods: Fourelectronic databases (Medline, PubMed, Embase and Google Scholar)were searched between 1995 and January 1st 2017 with nolanguage restrictions. From 3549 citations identified, a total of 26studies met the following inclusion criteria: (1) risk factors forrecurrence of prolapse were investigated; (2) the risk point estimatewas reported as an odds ratio (OR), or the data was presented suchthat an OR could be calculated; (3) the 95% confidence interval (CI)was reported, or the data was presented such that the CI could becalculated; (4) an internal comparison was used when calculating therisk estimate. We excluded studies that did not meet inclusioncriteria.
Results: Overall 26 studies met our inclusioncriteria with a sum of 6246 patients. 8 Studies were performed inEurope, 12 in America, 1 in Asia and 5 in Australia. The categorieson which a meta-analysis could be performed included: age -11studies, BMI -12 studies, staging of prolapse pre-operatively -10studies, levator avulsion-9 studies, Parity-7 studies,constipation/straining-6 studies, Number of compartments involved-5studies, Familial history and Hiatal area on valsalva-3 studies each.Several more parameters were evaluated by 2 studies each. For eachparameter a meta-analysis was undertaken. Meta-analysis that yieldedsignificant odds ratios (OR) and confidence intervals (CI) were foundfor: (1) levator avulsion with OR of 2.86 and CI 2.09-3.91, P-value<0.01. (2) Pre-operative staging 3, 3-4, 4 with OR of 2.08, 2.31,2.38 and CI 0.57-7.61, 1.62-3.29, and 1.49-3.78 respectively. (3)Familial history with OR of 1.84 and CI 1.19-2.86, P-value <0.01.For all other parameters ORs did not reach significance.
Figure 1: Levator avulsion aspredictor of prolapse recurrence
Figure 2: Pre-operative staging aspredictor of prolapse recurrence
Conclusions: Onmeta-analysis, levator avulsion, pre-operative prolapse stage andfamily history were found to be significant risk factors for prolapserecurrence after reconstructive surgery. Avulsion was identified asthe strongest individual predictor. Patients should be informedaccordingly.
1. Obstet Gynecol2009;113(3):609.
2. Obstet Gynecol 1997;89(4):501-6.
3. ObstetGynecol 2010;116(5):1096-100.