Patient-reported outcomes after hysterectomy due to pelvic organ prolapse versus other indications – a 10-year national follow-up study

We compared short- and long-term patient-reported satisfaction and outcomes after hysterectomy between women with and without pelvic floor dysfunction at the time of hysterectomy. The nationwide prospective FINHYST cohort was divided into two groups according to the indication for hysterectomy: those with pelvic organ prolapse (POP) with or without urinary incontinence (POPUI) (n = 1323) and those with other benign indications (non-POPUI, n = 2641). Outcomes were assessed via questionnaires at two months for all women and at ten years for the Helsinki University Hospital (HUH) subgroup (n = 838). The primary outcome was patient satisfaction measured by a visual analogue scale (VAS, 0-100); secondary outcomes included patient-reported outcomes and adverse events. Satisfaction was high at two months (mean VAS 88.1 POPUI vs. 89.8 non-POPUI, n.s) and remained high at ten years (89.2 POPUI vs. 92.5 no POPUI, p < 0.01). Women without POPUI reported greater satisfaction at ten years. At two months, fewer women in POPUI group had VAS scores under 70 compared to those in non-POPUI group (9.0% vs. 11.5%, p < 0.02). In both groups, the strongest predictors of dissatisfaction were reoperation, wound infection, and inadequate pain relief. At ten years, women with POPUI reported more frequently low VAS scores, (VAS < 70: 11.7% vs. 7.0%), persisted pelvic floor symptoms (86.7% vs. 64.0%, p < 0.01), and reoperations for POP (20.7% vs. 2.3%, p < 0.01). Short- and long term satisfaction following hysterectomy is high. Hysterectomy due to POP was associated with recurrent patient-reported pelvic floor symptoms, reoperations and higher risk of complications, reducing long-term satisfaction.