Risk factors for vaginal vault prolapse surgery in postmenopausal hysterectomized women.

OBJECTIVE: The purpose of this study was to identify risk factors for surgery of vaginal vault prolapse in hysterectomized postmenopausal women.

DESIGN: We conducted a case-control study. The cases were 117 consecutive postmenopausal hysterectomized women who underwent vaginal vault prolapse surgery at Danderyd Hospital or Karolinska Hospital, Stockholm, between 1996 and 2005. Control participants were 326 age-matched, randomly selected, hysterectomized women with no vaginal vault prolapse surgery, identified from the Swedish Inpatient Register. For participants and controls alike, data on determinants were extracted from patients' records, the Swedish Inpatient Register, and self-report questionnaires. Data were analyzed using nonparametric statistics and logistic regression.

RESULTS: The questionnaire was returned by 90 of 117 participants (77%) and 233 of 326 controls (71%). The mean age at response to the questionnaire was 72.8 (+/- 9.7 SD) and 71.3 (+/- 8.7 SD) years for participants and controls, respectively. In a multivariate analysis, the only predictors at a significant level were age at hysterectomy (odds ratio = 1.04, 95% CI: 1.004-1.08), prolapse or incontinence surgery before hysterectomy (OR = 2.8, 95% CI: 1.0-7.7), and prolapse or incontinence surgery before vaginal vault surgery (OR = 9.1, 95% CI: 3.6-23.4).

CONCLUSIONS: Postmenopausal women with surgically managed pelvic floor disorders are at increased risk of developing vaginal vault prolapse subsequent to a hysterectomy.