Outcome of various surgical procedures in management of pelvic organ prolapse

Background: Pelvic organ prolapse and urinary incontinence are common conditions affecting a large number of females.Many surgical procedures to correct these disorders are available according to the clinical presentation and surgical expertise of the surgeon.Currently there is no definitive gold standard procedure to favour a particular route in the treatment of uterine prolapse.Objectives: The present study was carried out to know the clinical presentation, variety of surgical options and outcome of surgical management in patients with pelvic organ prolapse.Methods: All women undergoing surgical treatment of pelvic organ prolapse and urinary incontinence at SMI Hospital of SGRRIM&HS, Dehradun were included in the study.The clinical presentation and the type of surgical treatment were recorded in every case.Outcome of surgical treatment and follow-up was recorded in terms of complications, patient satisfaction, quality of life and recurrence of symptoms.The data were analyzed and results were entered as percentage and frequency tables.Results: A total number of 408 patients were admitted and operated for pelvic organ prolapse.The mean age of the patient in our study was 54 years.Nearly two-third of the study population was employed in hard manual work involving strenuous activities, farmers (34.8%) and labourers (38%).Two hundred and seventy three (66.9%) of the women were postmenopausal, 403 (98.8 %) were multiparous and 315 (77.2 %) had some cause attributing to chronic increase in intra-abdominal pressure.The predominant presenting complaint was a history of mass protruding out of vagina in 329 (80.6%).The predominant type of prolapse was uterine prolapse in 381(93.4%)patients.Cystocele, rectocele, and enterocele were present in 298(73.0%),235(57.6 %) and 42(10.1%)patients respectively.Vaginal hysterectomy with pelvic floor repair was the predominant surgical treatment (73.5 %).Conclusion: Pelvic organ prolapse is associated with many risk factors of which few are modifiable.Despite a variety of surgical options available, vaginal hysterectomy with pelvic floor repair is the commonest surgery done for POP with satisfactory outcome.