Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study

Abstract

Objectives

To determine the lifetime risk of undergoing pelvic floor surgery in a cohort of UK parous women and the re-operation rates for pelvic floor surgery, time intervals for repeat surgery and independent risk factors for undergoing primary and repeat pelvic floor surgery.

Study design

A register linkage study.

Main outcome measures

The primary outcome was lifetime risk of parous women in the UK undergoing pelvic floor surgery for pelvic organ prolapse (POP), urinary incontinence (UI), and rectal prolapse or faecal incontinence (RP-FI). Secondary outcomes were re-operation rates and time interval of repeat surgery for POP/UI, and independent risk factors for undergoing primary and repeat pelvic floor surgery.

Results

34 631 women identified from the Aberdeen Maternity and Neonatal Database were linked with the Scottish Morbidity Records databases of NHS Scotland to assess relevant outcomes. The lifetime risk for women by age 80 years of undergoing any form of pelvic floor surgery was 12.2%. 2130 (6.2%) women had at least one pelvic floor surgery, of whom 407 (19%) had repeat operations. The median time intervals (IQR) between index and repeat UI and POP surgery were 2.80 (0.94–8.07) years and 3 (1.00–8.25) years, respectively. There is a reduced lifetime risk of pelvic floor surgery in women who had all deliveries by caesarean section (p<0.001) and those aged <20 years at first delivery (p=0.021). Women who sustained at least one perineal laceration (in the absence of a classified perineal tear) during delivery or who had at least one instrumental delivery with forceps use were at increased risk (p<0.001 and p=0.015, respectively).

Conclusions

Our study shows that in the UK more than one in 10 parous women will require at least one surgical procedure for pelvic floor disorders over their lifetime. The study also identifies independent risk and protective factors for pelvic floor surgery in parous women.

Article summary

Article focus

• Lifetime risk of undergoing various types of pelvic floor surgery in a cohort of UK women.

• Re-operation rates for various types of pelvic floor surgery and time intervals for repeat surgery.

• Independent risk factors for undergoing primary and repeat pelvic floor surgery.

Key messages

• The lifetime risk for women by age 80 years undergoing any form of pelvic floor surgery was 12.2%.

• The re-operation rate for pelvic floor surgery was 19%.

• There was a reduced lifetime risk of pelvic floor surgery in women who had all deliveries by caesarean section only and those aged <20 years at first delivery, while women who sustained at least one perineal laceration during delivery or who had at least one instrumental delivery with the use of forceps were at increased risk.

Strengths and limitations of this study

• To our knowledge, this is the first study to report the lifetime risk for women in the UK of undergoing surgical treatment for pelvic floor dysfunction.

• As the study represents the general population rather than a selected population, we are confident that our findings are generalisable to the UK or indeed any European population.

• The Aberdeen Maternity and Neonatal Database and Scottish Morbidity Records (SMR) databases used in this study are subjected to quality control measures at regular intervals and there are numerous consistency checks in place to ensure the validity of data entry.

• We were unable to link 27% of women with the SMR databases.