INTRODUCTION: Ehlers–Danlos syndrome (EDS) comprises heritable collagen disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Reports suggest a link between EDS and pelvic organ prolapse (POP), but postoperative outcomes after POP surgery in EDS remain poorly defined. OBJECTIVE: To estimate the rate of POP re-treatment after surgery in patients with EDS (pessary or re-operation) and describe perioperative complications and time to re-treatment. METHODS: Retrospective cohort of patients with presumed EDS identified by ICD-10 codes who underwent urogynecologic procedures (CPT-based capture) at a tertiary care center from January 2014 and June 2024. Demographics, surgical approach, 30-day outcomes, and subsequent POP re-treatments were abstracted. RESULTS: Thirty-seven patients met inclusion criteria (mean age 45.4 years; mean BMI 27.4). EDS subtypes were unspecified (n=19), hypermobile (n=15), and classical (n=3). The majority of patients were White, did not have comorbidities including diabetes, hypertension, or cardiopulmonary disease. Prior operations included POP surgery (24.3%) and rectal prolapse surgery (16.2%). Most presented with stage 2 POP. Primary surgeries were native-tissue repairs in 62.2% (uterosacral ligament suspension 24.3%, anterior repair 24.3%, posterior repair 59.5%); mesh procedures in 37.8% (sacrohysteropexy 8.1%, sacrocolpopexy 18.9%, rectopexy 10.8%). Concomitant anti-incontinence procedures occurred in 35.1%. Median estimated blood loss was 90 mL 50–150. Same-day discharge occurred in 59.5%; 30-day readmission and return to OR were 10.8% and 5.4%, respectively. Overall, 24.3% experienced a postoperative complication (Clavien–Dindo: Grade I 8.1%, Grade II 10.8%, Grade IIIa 2.7%, Grade IIIb 2.7%). Postoperative pelvic floor physical therapy was utilized by 43.2% of patients and did not differ across EDS subtypes (p=0.54). During follow-up, 29.7% (11/37) underwent POP re-treatment for symptomatic POP: 5.4% with pessary and 24.3% with re-operation. Median time to pessary was 35.6 months 24.6–46.5 and median time to re-operation was 14.5 months 9.6–27.2. CONCLUSIONS: In this EDS cohort, nearly one-third required re-treatment after POP surgery, more often with re-operation than pessary. Re-operation occurred earlier than conservative re-treatment. Early perioperative morbidity and 30-day readmission and reoperation were low. These data highlight the need for counseling EDS patients about recurrence risk and for prospective, subtype-stratified studies evaluating durability by procedure type.Table 1Table 2
Cevigney et al. (Fri,) studied this question.