Can we predict the evolution of untreated first stage posterior vaginal wall prolapse in women operated for anterior or apical prolapse?

Objective: The aim of this study was to evaluate the correlation between pre-existing conditions and worsening of Stage I untreated posterior vaginal wall prolapse (PVWP) after vaginal hysterectomy and anterior repair at 12-month follow-up. Methods: This is a multicenter retrospective study. Women with symptomatic (vaginal bulging and low back pain) anterior and/or apical pelvic organ prolapse (POP) and I stage PVWP were enrolled. Patients were submitted to vaginal hysterectomy and native-tissue anterior vaginal wall repair. Risk factors for POP development were collected for each woman before surgery. At 12 month-follow-up after surgery, women were evaluated and divided into two groups depending on the anatomical finding of the posterior vaginal wall according to the Pelvic Organ Prolapse Quantification System: women with Persistent I stage PVWP and patients with worsened PVWP more than or equal to II stage. Difference of distribution of risk factors for POP between the two groups was evaluated. Correlation between risk factors and development of PVWP more than I stage was assessed. Results: Seventy women were submitted to POP surgery. Significant difference in constipation before surgery and degree of anterior and central vaginal compartments descent was observed (p <.01) between the two groups. Constipation before surgery resulted as an independent factor in worsening of PVWP at 12-month follow-up (p value =.01; odds ratio 1.99 [1.49–2.33]). Conclusion: Untreated Stage I PVWP, not included in the first surgical repair, can significantly get worse in women complaining of constipation at 12-month follow-up.