Is procidentia a distinct disease? Comparison of risk factors

Abstract

Aim: Total prolapse—in other words, procidentia—refers to the complete eversion of the total length of the vagina. Age, pregnancy, delivery, previous pelvic surgery, and conditions that increase intra-abdominal pressure, such as chronic pulmonary disease, constipation, and obesity are risk factors for pelvic organ prolapse. This study aims to assess the incidence of anterior, posterior, apical, and total prolapse and to determine differences in the risk factors for different vaginal compartment prolapse, total prolapse, and subtotal prolapse. Material and Method: This is a retrospective study of patients who underwent prolapse surgery. Comparison of possible risk factors such as parity, age, body mass index, menopause, and preoperative laboratory results were done between women with total and subtotal uterovaginal prolapse by using one way analysis of variance, chi-square, and Fisher tests. Results: A total of 29 women had total uterovaginal prolapse among 179 women who underwent prolapse surgery. Women with subtotal prolapse (29.4±3.7) were significantly more obese than women with total prolapse (26.1±3.3), (p<0.001). Age, parity, hysterectomy history, and menopause status were similar. Multiparity was less in women with dominant anterior vaginal wall defect than in others (52.4% vs. 70.5-88.9%, p=0.03). Discussion: We hypothesized that total uterine or vault prolapse is a different entity that has some specific risk factors other than the primary known risk factors of delivery and age. Women with procidentia were thinner and anterior vaginal wall prolapse was less strongly associated with multiparity. Future studies are needed to understand the pathophysiology of total uterovaginal prolapse.