Abstract
Introduction and hypothesis
Recent findings address the importance of Level III defects with increased genital
hiatus being associated with pelvic organ prolapse (POP), correlated with Level I
defects and strongly related to POP recurrence. We hypothesised that concomitant perineorrhaphy
in POP repair reduces genital hiatus (gh) and increases perineal body (pb), that gh
would be larger with number of vaginal deliveries and that patients’ QoL was not different
comparing sexually active vs. inactive patients with overall judgement of cure comparable
to the literature at evaluation.
Methods
Retrospective observational study including consecutive patients with indications
for posterior repair and Level III support between 2016 and 2018. Concomitant perineorrhaphy
was indicated due to complaints of wide introitus or genital hiatus of ≥ 3.5cm. Primary
objective was to compare pre- and post-operative gh and pb according to POP-Q, secondary
objectives were pre-operative gh and pb values by parity, POMs obtained with P-QOL/D
comparing sexually active vs. inactive patients, and subjective judgement of cure
according to EGGS system.
Results
In n = 121 patients, mean gh value was reduced post-operatively by 29.5% (31 ± 6 vs.
44 ± 10 mm, p < 0.001), mean pb value increased by 25.5% (47 ± 8 vs. 35 ± 8 mm; p
< 0.001). Influence of parity on pre-operative gh (p = 0.020), but not pb values (p
= 0.119) was observed. All P-QoL/D domain scores improved significantly postoperatively
without differences seen in sexually active vs. inactive patients. EGGS responses
indicated partial/full goal achievement in 90% and cure in 87%.
Conclusions
In the study cohort, perineorrhaphy as concomitant in POP repair led to Level III
support reflected by decreased genital hiatus size. Functional QoL was improved regardless
of sexual activity status and the majority of patients reported partial or full cure.
Keywords
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Article Info
Publication History
Accepted:
November 21,
2022
Received in revised form:
October 6,
2022
Received:
August 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier B.V.
