RCOG World Congress 2025

Objective: How to prevent the recurrence of UV prolapse after pelvic floor surgery.

Design: Retrospective case note analysis of patients who were treated surgically for UV(uterovaginal) prolapse in a district general hospital between 15th May 2018 to 15th May 2021(3 years).

Method: Patients were identified from the theatre log for urogynaecological surgery for uterovaginal prolapse (UV prolapse). This information was cross-referenced with medical records and operation notes. Recorded details included age, parity, BMI, co-morbidities, previous surgeries, complications, operative findings, and surgery type.

Results: 236 Patients met the inclusion criteria with an age range between 42 and 84 years old. Out of these 236 patients, 67 patients had a history of previous pelvic floor repair, and 41 patients presented with recurrence. 11 patients had a history of previous repair and, after 2nd surgery, presented with recurrence again, and 2 of them had 3rd surgery. Out of 41 patients who presented with recurrence,10 had repeat surgery. The general rate of recurrence after PFR was 17.37. Recurrence was 82% in post-menopausal women. Recurrence was highest in the anterior+posterior repair group at 34.14%. Recurrence in other groups was as follows,

ØPost. repair group 29.26%

ØAnt. repair group 26.8%

Ø SSF (sacrospinous fixation) 7.31%

ØRecurrence was more common in BMI <30 in all groups and ages 22% of women with recurrence had co-morbidity as Asthma, COPD (risk factors for UV prolapse as a result of increased intra-abdominal pressure). Most patients in the recurrence group had hypertension, likely age-related and not a risk factor for uterine prolapse. Five percent had a history of total hysterectomy with vault prolapse, and five percent had fibromyalgia.

Conclusion: Based on the results presented above, the following recommendations are suggested:

Ø Improve access to primary and secondary care for timely investigation and treatment, potentially reducing invasive surgery and recurrence.

Ø Educate women on the early signs of uterine prolapse and the importance of seeking prompt medical advice. Promote pelvic floor exercises after vaginal deliveries to strengthen muscles and enhance long-term outcomes.

Ø Establish effective clinical pathways for pelvic floor weakness with prompt GP referrals to physiotherapy to minimize the need for invasive treatments.

ØConduct ongoing audits to monitor the prevalence and management of uterine prolapse, helping to identify areas for improvement.

RCOG World Congress 2025

Recurrence of Uterovaginal Prolapse After Pelvic Floor Surgery.

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