Reviewer’s report
Title: 
Long-term pelvic floor symptoms and urogenital prolapse after
hysterectomy
Version: 
0 
Date: 
04 Feb 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: Hysterectomy is a common procedure performed in
women. 
Few study have examined the long-term health impact of hysterectomy
on patient quality of life and symptoms. 
The current study examined the long-
term impact of pelvic floor symptoms and urogenital prolapse after
hysterectomy. Goals and objective of the study are clearly defined. 
The study
generates important long-term data to counsel and monitor patients after
hysterectomy. The paper is well written. Comprehensive data analysis was
performed in various subgroups. 
The authors 
linked the pelvic floor symptoms to
different pelvic floor anatomy derangements 
which is quite unique.
REQUESTED REVISIONS: 
A few additional clarifications would further strengthen the manuscript
1. 
Line 69 : Please provide a reference support the validity of the Pelvic Floor
Distress Inventory (PFDI-20). What would be the cut off score to define clinical
relevance symptoms ?
2.Line 86 : For the POP-UP study, please provide a brief description of the
inclusion criteria. 
Also was the technique of laparoscopic hysterectomy and
vaginal hysterectomy standardized ? 
Was the surgical technique for vagina vault
closure and vault suspension after hysterectomy standardized in this study ?
What was the proportion of patients undergoing concurrent bilateral salpingo-
oophorectomy with hysterectomy in the POP-UP study as this would be
relevance to long-term pelvic support in patient with premature menopause.
3.Line 112-13 : Was medical comorbidities and smoking history included in the
risk factors being assessed in this study in term of pelvic organ prolapse ?
4.Line 288-9 : The authors have shown that PFS are very common 
regardless of
whether pelvic organ prolapse is present or not after hysterectomy. 
Was there
any comparative data in the general Dutch population with no prior history of
hysterectomy regarding the prevalence of PFS ?
5. 
Considering the high prevalence of PFS after hysterectomy, can the authors
recommend any potential prophylactic interventions to lessen the chance of
developing PFS ? 
Any role for pelvic physiotherapy ?
ADDITIONAL REQUESTS/SUGGESTIONS: 
see above
Declaration of competing interests
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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