Hysterectomy increases risk of prolapse surgery.

HOLLYWOOD, FLA. -- Hysterectomy, regardless of surgical approach, increases the risk of future pelvic organ prolapse surgery. In addition, risk is greatest within the first 5 postoperative years, according to a national Swedish database study.

Dr. Daniel Altman and his associates identified 162,488 women from the Swedish Inpatient Registry who had a hysterectomy for a benign indication between 1973 and 2003. They then randomly matched each of these cases with 3 women from the general population for a control group of 470,519 women without a history of hysterectomy. Mean follow-up time was almost 12 years.

They investigators analyzed the inpatient register for the occurrence of pelvic organ prolapse surgery for both cohorts. All participant names were checked against the 1990 census, the medical birth registry, immigration registry, cancer registry, and cause of death registry in Sweden, said Dr. Altman, who is with the department of obstetrics and gynecology, Karolinska Institutet and Danderyd Hospital in Stockholm.

Risk for subsequent pelvic organ prolapse surgery was calculated as a hazard ratio. Compared with women in the control group, women who had a total abdominal hysterectomy had a 1.9 times increased risk. A subtotal abdominal hysterectomy conferred a 2.0 increased risk; vaginal hysterectomy, a 3.8 increased risk; laparoscopic, a 5.5 increased risk; and laparoscopic-assisted vaginal, a 7.5 increased risk. Women in the two vaginal hysterectomy groups had the greatest combined risk, Dr. Altman said at the annual meeting of the American Urogynecologic Society.

Parity, county of residence, and age were among the covariates studied. "Even after adjusting for these, vaginal hysterectomy was again associated with the highest risk for pelvic organ prolapse."

The first 5 years following hysterectomy were associated with the highest risk for subsequent prolapse surgery, Dr. Altman said. After the initial 5-year period, risk rates were attenuated among all cohorts.

A meeting attendee asked if the higher rate of subsequent surgeries in the first years after hysterectomy might reflect prolapse initially missed by the surgeon. "I agree there is a peak in the first 2 years after hysterectomy," Dr. Altman replied.

"I think the reason for this is a patient having a successful hysterectomy procedure who develops symptoms is more likely to see a surgeon again. But I don't think undiagnosed pelvic organ prolapse is a major issue here." He added, "These patients were examined at time of hysterectomy and, if there was clinically significant prolapse, it would have been diagnosed."

BY DAMIAN MCNAMARA

Miami Bureau