Intermediate term outcomes after transvaginal uterine-preserving surgery in women with uterovaginal prolapse

Abstract

Introduction and hypothesis There is growing interest in and performance of uterine-preserving prolapse repairs. We hypothesized that there would be no difference in pelvic organ prolapse (POP) recurrence 2 years following transvaginal uterosacral ligament hysteropexy (USLH) and sacrospinous ligament hysteropexy (SSLH). Methods This is a retrospective cohort study with a cross-sectional survey of women who underwent transvaginal uterine-preserving POP surgery from May 2016 to December 2017. Patients were included if they underwent either USLH or SSLH. POP recurrence was defined as a composite of subjective symptoms and/or retreatment. A cross-sectional survey was used to assess pelvic floor symptoms and patient satisfaction. Results A total of 47 women met the criteria. Mean age was 52.8 ± 12.5 years, and all had a preoperative POP-Q stage of 2 (55.3%) or 3 (44.7%). Thirty (63.8%) underwent SSLH and 17 (36.2%) underwent USLH. There were no differences in patient characteristics or perioperative data. There was no difference in composite recurrence (26.7% [8] vs 23.5% [4]) and retreatment (6.7% [2] vs 0%) retrospectively between SSLH and USLH groups at 22.6 months. Survey response rate was 80.9% (38) with a response time of 30.7 (28.0–36.6) months. The majority of patients (84.2%) reported POP symptom improvement, and both groups reported great satisfaction (89.5%). In respondents, 13.2% (5) reported subjective recurrence and 5.3% (2) underwent retreatment, with no differences between hysteropexy types. There were no differences in other pelvic floor symptoms. Conclusions Although 1 in 4 women experienced subjective POP recurrence after transvaginal uterine-preserving prolapse repair and <5% underwent retreatment at 2 years, our results must be interpreted with caution given our small sample size. No differences in outcomes were identified between hysteropexy types; however, additional studies should be performed to confirm these findings. Both hysteropexy approaches were associated with great patient satisfaction. Supplementary Information The online version contains supplementary material available at 10.1007/s00192-021-04987-5

Sacrospinous Fixation and Vaginal Uterosacral Suspension—Evaluation in Uterine Preservation Surgery

“…[8][9][10][11] Overall, there are little data published comparing the surgical outcomes and incidence of adverse events associated with the 2 types of vaginal hysteropexy. [12][13][14] Sacrospinous and uterosacral suspension procedures at the time of hysterectomy have been compared in the OPTIMAL Trial, 15 and over the long term, there are no differences in outcomes between the 2 suspension procedures. 16 Although it is tempting to extrapolate these data to hysteropexy techniques, it cannot be assumed that these procedures will perform similarly with uterine conservation.…”

“…Most of the data on vaginal hysteropexy are on the SSHP technique and have shown that SSHP has a similar cure rate when compared with vaginal hysterectomy with native tissue repair and may even be associated with fewer adverse events 8–11 . Overall, there are little data published comparing the surgical outcomes and incidence of adverse events associated with the 2 types of vaginal hysteropexy 12–14 . Sacrospinous and uterosacral suspension procedures at the time of hysterectomy have been compared in the OPTIMAL Trial, 15 and over the long term, there are no differences in outcomes between the 2 suspension procedures 16 .…”