Long-term patient-reported outcome for surgical management of pelvic organ prolapse: A retrospective cohort study

Objectives: Pelvic organ prolapse (POP) has traditionally been treated by vaginal native tissue repair. This study aimed to review two cohorts of women surgically treated for POP regarding surgical characteristics, and compare long-term outcomes based on subjective satisfaction and surgeon experience. Study design: Retrospective cohort study of 490 women undergoing a primary native-tissue POP procedure during 2002-2004 (cohort 1, n = 201), or during 2012-2014 (cohort 2, n = 289). Patient-reported questionnaire data were collected in 2008 (cohort 1) and 2018 (cohort 2, and repeat survey cohort 1 (n = 97)). Clinical data were collected from patient files. Outcomes were assessed by Kaplan-Meier/log-rank test, binary logistic regression and Cox multivariate analysis. Results: Women in cohort 2 were operated at a younger age (median 64 versus 66 years, p < 0.001) with grade 2 as dominant prolapse (156/289, 54 %), versus grade 3 dominant prolapse (130/201, 65 %, p < 0.001) in cohort 1. In cohort 2 a higher proportion (172/289 (60 %) versus 39/201 (19 %), p < 0.001) were operated with a procedure including all three compartments (anterior, apical and posterior). For 24 % (117/490) of all patients a peri-/postoperative procedure-related complication was noted. After a median observation time of 163 months (cohort 1, 95 % confidence interval 160-169) and 63 months (cohort 2, 95 % confidence interval 62-64), a total of 43 patients (9 %) had been subjected to further prolapse surgery, median 41 months (95 % confidence interval 23-72) after the primary surgery. In all, 89 % of women (176/196 cohort 1, and 253/285 cohort 2, p = 0.722) were very/somewhat satisfied 4-6 years postoperatively, although 18 % (38/193 in cohort 1 and 50/282 in cohort 2) still reported prolapse symptoms. After 14-16 years 88 % (84/97) remained satisfied, but 31 % (30/97) reported prolapse symptoms. Neither satisfaction, peri-/post-operative complications, nor reoperation-rate differed regarding lead surgeon experience-level (gynecologist in-training versus specialist). Conclusions: Women operated by primarily native-tissue POP surgery report high levels of satisfaction, even 15 years after surgery, despite 31 % reporting prolapse related symptoms. Outcomes were similar regardless of lead surgeon being in-training or certified gynecologist.