Risk of pelvic organ prolapse after hysterectomy for benign conditions: A nationwide cohort study

Objective

To assess the risk of pelvic organ prolapse (POP) after hysterectomy for benign conditions.

Study design

This nationwide retrospective cohort study, utilizing data from the Korean National Health Insurance Service database, compared women aged 40 to 59 who underwent benign hysterectomy between 2002 and 2011 (hysterectomy group) with those who had national medical examinations during the same period (nonhysterectomy group). The analysis used a 1:1 propensity score matching method adjusted for variables.

Main outcome measure

Incident POP.

Results

The final sample of 32,984 participants (16,492 in each group) had a median age of 47 years [45–50] (p-value 0.305) and a median follow-up of 11.4 years [10–13.3] (p-value 0.189). The incidence of POP was 0.5 % in the nonhysterectomy group and 0.6 % in the hysterectomy group. Hysterectomy was associated with an increased risk of POP that required surgery or pessary use (hazard ratio [HR] 1.403, 95 % confidence interval [CI] 1.026–1.919). Subtotal hysterectomy was not associated with an increased risk of POP (HR 1.868, 95 % CI, 0.624–5.593), while total hysterectomy was associated with an increased risk (HR 1.633, 95 % CI, 1.083–2.46). Laparoscopic surgery was not associated with an increased risk of POP (HR 0.611, 95 % CI 0.311–1.202).

Conclusions

The study found that, overall, hysterectomy is linked to a higher risk of POP, but subtotal hysterectomy and laparoscopy are not associated with increased risk, while total hysterectomy is associated with a higher risk.