Five Year Prevalence of Pelvic Organ Prolapse after Vaginal Hysterectomy with Prophylactic Apical Support

Objective: This study evaluated the 5-year prevalence of symptomatic pelvic organ prolapse (POP) after total vaginal hysterectomy (TVH) with simultaneous prophylactic apical support and compared demographic characteristics between women who did and did not develop POP. Materials and Methods: This was a case-control study of women > 45 years who underwent prophylactic McCall's culdeplasty during vaginal hysterectomies for benign indications (excluding baseline prolapse). A retrospective chart review was performed using Current Procedural Terminology codes 58260 and 58290 for hysterectomy within the Mayo Clinic from May 1, 2000, to May 1, 2013. The development of POP, diagnosed by pelvic examination by a gynecologic surgeon or primary-care provider, was evaluated. Results: Inclusion criteria were met by 263 patients, who were 93.5% non-Hispanic and 88.9% white. The average age at TVH was 49.9 years (range: 45-77 years). Median parity was two deliveries (range 0-9 deliveries). For women who had at least one delivery, 89.4% had at least one vaginal delivery. Nine of 263 women developed POP, resulting in a 5-year prevalence of 3.4%. No statistically significant differences in age, race, body mass index, number of deliveries, or history of smoking were found between women who did and did not develop prolapse. Conclusions: McCall's culdeplasty during hysterectomy is associated with a subsequent symptomatic prolapse prevalence of 3.4%. Apical suspension could be protective for all women who undergo hysterectomies for benign indications, regardless of prolapse-specific risk factors.