Abstract
Background/Objectives: Pelvic floor disorders (PFDs) have multifactorial etiology. This makes treatment challenging and often unsatisfactory. This project introduces robust data on risk factors for PFDs and explores opportunities for their prevention, focusing on previous gynecological surgical interventions. Methods: We conducted a retrospective analytical cohort study analyzing demographic and clinical data from 832 consecutive patients who underwent pelvic organ prolapse (POP) surgery at a teaching hospital affiliated with the University of Cologne between 2010 and 2019. Patient characteristics-including age, body mass index (BMI), parity, mode of delivery, and symptoms-were collected from medical records. Associations between patient factors and surgical history were assessed using Kendall's Tau (KT) for correlations and relative risks (RRs) with 95% confidence intervals (CIs) to evaluate the impact of previous hysterectomies and pelvic surgeries on PFD. Results: First vaginal delivery and age were the strongest factors associated with PFD. BMI had a smaller impact, and multiple vaginal deliveries did not significantly influence apical (KT 0.037), posterior (KT 0.007), anterior midline (KT 0.015), or lateral defects (KT 0.015). Cesarean section was protective. Subtotal hysterectomy showed no significant association with PFD. Total hysterectomy was strongly associated with posterior defects (RR 4.750, 95% CI: 1.871-12.059) and anterior midline defects (RR 1.645, 95% CI: 0.654-4.139). Recurrent urinary infections were associated with abdominal colposuspension (RR 4.485, 95% CI: 1.12-18.03). Dyspareunia occurred more frequently after vaginal (RR 3.971, 95% CI: 0.78-20.14) and abdominal hysterectomy (RR 1.620, 95% CI: 0.32-8.15). Vaginal hysterectomy was linked to fecal incontinence (RR 5.559, 95% CI: 1.17-26.30), MUI (RR 2.156, 95% CI: 1.09-4.23), and UUI (RR 4.226, 95% CI: 1.82-6.85). Conclusions: The factors identified as influencing (PFD) offer a solid foundation for evidence-based patient counseling within our population. Our large dataset confirmed key risk factors, notably childbirth and advancing age. However, the influence of BMI on symptoms and anatomical defects appears to be less significant than previously assumed. Subtotal hysterectomy was not associated with new PFD in our cohort and may represent a viable option when hysterectomy is indicated, though further studies are needed to confirm this potential advantage.