Epidemiology of Re-Operation for Surgically-Managed Pelvic Organ Prolapse (POP) and Urinary Incontinence (UI)
Drs. Amanda Clark+, T. Gregory, V. Smith, R. Edwards
Oregon Health and Science University
Portland, Oregon

OBJECTIVE:   Our aim was to determine the incidence of re-operation of surgically managed POP and UI in a population-based cohort. 
METHODS:    In 1995, a cohort of 383 women undergoing surgical treatment for POP and UI were identified by ICD-9 and CPT codes within the Kaiser Permanente Northwest membership (KPNW).  Subjects who underwent repeat surgery for POP and UI were identified by ICD-9 and CPT codes during the following 5 years, 1996-2000.  The KPNW membership includes 149,554 women ages 20 or older, and its ethnicity is 91.4% Caucasian, 2.6% African American, 1.1% Native American, and 2.4% Asian.  A standardized data collection form was used to record age, race, body mass index, vaginal parity, smoking history, medical history, and surgical history including the preoperative evaluation, indication and details of the 1995 procedure and prior surgical procedures. Seventy-four per cent (282) of the subjects were still enrolled with KPNW at the end of the study period. 
RESULTS:   Thirty-two women (8.4%) underwent re-operation within 5 years, with a mean incidence of 1.7% re-operations per year.   Parity was inversely associated with re-operation, with a history of 2.3 pregnancies in the group who underwent re-operation, compared to 3.1 pregnancies in the group who did not (p=0.01, Student’s t-test).  There was no association with age, body mass index, the number of prior surgeries, Caucasian race, chronic lung disease, smoking, and severity of apical, anterior, or posterior wall prolapse. 
CONCLUSIONS:  The incidence of repeat operations for surgically-managed POP and UI is high, and this probably represents an underestimate of the true incidence.
KEY WORDS : urinary incontinence, pelvic organ prolapse, epidemiology