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Epidemiology
Research
Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study
  1. Mohamed Abdel-fattah1,
  2. Akinbowale Familusi1,
  3. Shona Fielding2,
  4. John Ford2,
  5. Sohinee Bhattacharya3
  1. 1Urogynaecology, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  2. 2Population Health, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  3. 3Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Mohamed Abdel-fattah; m.abdelfattah{at}abdn.ac.uk

Abstract

Objectives To determine the lifetime risk of undergoing pelvic floor surgery in a cohort of UK parous women and the re-operation rates for pelvic floor surgery, time intervals for repeat surgery and independent risk factors for undergoing primary and repeat pelvic floor surgery.

Study design A register linkage study.

Main outcome measures The primary outcome was lifetime risk of parous women in the UK undergoing pelvic floor surgery for pelvic organ prolapse (POP), urinary incontinence (UI), and rectal prolapse or faecal incontinence (RP-FI). Secondary outcomes were re-operation rates and time interval of repeat surgery for POP/UI, and independent risk factors for undergoing primary and repeat pelvic floor surgery.

Results 34 631 women identified from the Aberdeen Maternity and Neonatal Database were linked with the Scottish Morbidity Records databases of NHS Scotland to assess relevant outcomes. The lifetime risk for women by age 80 years of undergoing any form of pelvic floor surgery was 12.2%. 2130 (6.2%) women had at least one pelvic floor surgery, of whom 407 (19%) had repeat operations. The median time intervals (IQR) between index and repeat UI and POP surgery were 2.80 (0.94–8.07) years and 3 (1.00–8.25) years, respectively. There is a reduced lifetime risk of pelvic floor surgery in women who had all deliveries by caesarean section (p<0.001) and those aged <20 years at first delivery (p=0.021). Women who sustained at least one perineal laceration (in the absence of a classified perineal tear) during delivery or who had at least one instrumental delivery with forceps use were at increased risk (p<0.001 and p=0.015, respectively).

Conclusions Our study shows that in the UK more than one in 10 parous women will require at least one surgical procedure for pelvic floor disorders over their lifetime. The study also identifies independent risk and protective factors for pelvic floor surgery in parous women.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000206

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    Footnotes

    • To cite: Abdel-fattah M, Familusi A, Fielding S, et al. Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open 2011;1:e000206. doi:10.1136/bmjopen-2011-000206

    • Funding This research was funded by an NHS Grampian Endowment grant for data linkage and administrative work. The University of Aberdeen acted as sponsors for this research project, but the findings and their interpretation in this study are the authors' own. All authors were employed by the University of Aberdeen at the time of conducting this research.

    • Competing interests None.

    • Ethics approval This research proposal was approved by the Steering Committee of the Aberdeen Maternity and Neonatal Databank and the Privacy Advisory Committee of the Information and Services Division NHS Scotland.

    • Contributors MAF conceived the research idea, wrote the first draft of the paper and was responsible for the clinical interpretation of the findings. AF facilitated data linkage, cleaned the linked data and conducted initial analyses. SF conducted and supervised all statistical analyses. JF conducted initial literature searches. SB gave methodological support in the designing of the study and extraction and linkage of data. All authors contributed to the writing of the final draft of the paper. MAF is the guarantor of this paper.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data tables and summaries are available from corresponding author at m.abdelfattah{at}abdn.ac.uk.