Cross-sectional study to assess the prevalence of vaginal vault prolapse after laparoscopic hysterectomy as a long-term complication.

Rationale: Hysterectomy in general is a proven risk factor for pelvic organ prolapse (POP), which can seriously discomfort women at any age and often results in surgical repair. Long-term studies for pelvic organ prolapse after the recently added laparoscopic approach have not yet been performed. Because the uterosacral ligaments have an important function for the level one support of the pelvic floor and are not harmed during laparoscopy, we believe that laparoscopic hysterectomy (LH) might result in less long-term POP problems compared to VH, when performed for the same, benign indication.

Objective: The primary objective of this study is to review the incidence of pelvic organ prolapse after laparoscopic hysterectomy compared to vaginal hysterectomy.

Patients and Methods: A cohort study will be performed of patients who underwent laparoscopic or vaginal hysterectomy in a single center in the period of 1996 to 2004. The following items will be examined: prolapse treatment (both conservative and surgical), current pelvic floor complaints and observed POP on POP-examination. We will use a questionnaire (PFDI-20) and patients will undergo a one-time pelvic floor exam using the POP-Q. The population will exist of women, aged thirty to eighty, who underwent laparoscopic or vaginal hysterectomy for benign indications between 1996 and 2004 in the Máxima Medical Center (MMC).

The primary objective of this study is to review the prevalence of pelvic organ prolapse after laparoscopic hysterectomy compared to vaginal hysterectomy. Because the uterosacral ligaments are the important structure for vault suspension after hysterectomy and are not harmed during laparoscopy, we hypothesize that laparoscopic hysterectomy results in less long-term prolapses compared to vaginal hysterectomy

Both the questionnaire and POP-Q exam will take place before end of the study.

- Questionnaire: PFDI-20 (pelvic floor distress inventory), validated in Dutch population. This questionnaire entails questions on pelvic floor problems and/or discomfort within the last three months. Details on micturition, defecation and other prolapse symptoms are addressed.

- Physical examination: POP-Q pelvic organ prolapse quantification. This is a validated, non-invasive, safe way to objectify pelvic organ prolapse during pelvic floor exam.