(Poster 94) Vaginal Wound Healing in Heme Cancer Survivors After Vaginal Prolapse Surgery

Objectives: There is no current data published investigating the relationship between vaginal adhesion formation following vaginal prolapse surgery in hematologic cancer survivors. We sought to determine if there is an increased rate in vaginal adhesions and associated complications in a hematologic cancer survivor population compared to a benign population following vaginal prolapse repair.

Methods: A single-institution retrospective study was approved by the Institutional Review Board. Electronic medical records were reviewed to first compile a list of patients with a history of hematologic malignancies who were treated at the study site, and patients who underwent urogynecologic surgical procedures were then identified for data collection.

Patients were selected in this cohort who had urogynecologic procedures from 2013 through 2021. Further, patients were included only if they had vaginal prolapse repair including anterior/posterior repair, apical suspension, or vaginal hysterectomy. For patients who had multiple surgeries during this period, only the first surgery was counted. All surgical procedures identified were performed by a single surgeon. Patients with hematologic malignancies were compared with patients who did not have a cancer diagnosis at the time of surgery. Baseline clinical and demographic characteristics, prior treatments and surgical information was summarized and compared between hematologic malignancy patients vs. benign patients, using number and percent and median and interquartile range (IQR), respectively. Baseline characteristics, clinical results and complication rates were compared using the chi-square (or Fisher’s exact) test for discrete variables, and t-test (or Wilcoxon rank-sum test) to compare continuous data.

Results: 29 patients with history of hematologic malignancy and 491 patients with no history of cancer underwent transvaginal prolapse repair from 2013 to 2021. Baseline characteristics across all groups were similar. Median blood loss (EBL) was lower in the hematologic malignancy cohort vs. the non-cancer cohort (75 ml vs. 100 ml, p=0.03). Vaginal defect occurred at a higher rate in hematology patients compared with patients with no known cancer diagnosis 6.9% vs. 0.6% (p-value 0.027 fisher’s exact test). Primary difference in the rate of complications was in vaginal septum/adhesion, which was more common in the hematology group (6.9 % vs. 1.0 %, p=0.05). Other differences were not statistically significant (e.g., urinary retention: p=0.6, chi-square test).

Conclusions: Women with hematologic cancer had a higher rate of vaginal adhesion complications from prolapse surgery compared to women without cancer. More research is needed to corroborate these findings and determine if length of time on cancer therapy and time since last adjuvant therapy affects the rate of vaginal adhesion formation. Additionally, further research is needed to elucidate other cancers and radiation treatment which may increase risk of vaginal adhesion.