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Native-tissue pelvic organ prolapse (POP) repair with perineorrhaphy for Level III support results in reduced genital hiatus size and improved quality of life in sexually active and inactive patients

  • Anke R. Mothes
    Affiliations
    Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany

    Current address: Department of Gynaecology, St. Georg Hospital Eisenach, Academic Teaching Hospital of University of Jena, Jena, Germany
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  • Isabel Raguse
    Affiliations
    Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany

    Department of Traumatology Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany
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  • Angela Kather
    Affiliations
    Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany
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  • Ingo B. Runnebaum
    Correspondence
    Corresponding author at: Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Adress: Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany.
    Affiliations
    Department of Gynaecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747 Jena, Germany
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Published:November 23, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.11.023

      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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