One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study

Abstract

Introduction and hypothesisIn a retrospective study, the sacrospinous hysteropexy was associated with a shorter recovery time compared to a vaginal hysterectomy with no differences in anatomical outcomes. No randomized trials are performed.MethodsSixty-six women with stage 2–4 uterine descent were randomized for vaginal hysterectomy(31) or sacrospinous hysteropexy(35). Recovery time, anatomical outcomes, functional outcomes, and quality of life were measured.ResultsLength of time to return to work was shorter after a sacrospinous hysteropexy (43 versus 66 days, p = 0.02). The difference in risk for recurrent prolapse stage 2 or more of the apical compartment at 1-year follow-up was 17% (95% confidence interval, 2 to 30) in favor of the vaginal hysterectomy. No differences in quality of life and urogenital symptoms were found.ConclusionsThe sacrospinous hysteropexy for uterine descent is associated with an earlier recovery time, more recurrent apical prolapses but no differences in functional outcomes, and quality of life.

Hysteropexy compared to hysterectomy for uterine prolapse surgery: does durability differ?

“…The skew in our population echoes de Boer's recent work, in which the vaginal hysterectomy group had higher grade of preoperative global pelvic organ prolapse [11]. Avoiding some element of demographic and/or clinical skew when comparing hysterectomy to hysteropexy groups is indeed challenging, but perhaps less so than prospective randomization of the prolapsed uterus, as detailed in one prospective randomized trial of sacrospinous fixation hysteropexy vs. hysterectomy in which only 17% of eligible candidates agreed to randomized removal or retention of the uterus [13]. Nevertheless, as with any retrospective analysis, a prospective randomized study would improve accuracy of outcomes analysis, as would longer term of follow-up.…”

“…This new vaginal uterosacral hysteropexy method of uterine resuspension expands the surgical options and outcomes counseling for women considering uterine prolapse surgery, women whose salient concerns typically include "how long it will last" and whether or not the uterus "should be removed" or "really needs to be removed" [6][7][8][9][10][11][12][13].…”

“…Uterosacral hysteropexy is a new vaginal prolapse operation that uses the uterosacral ligaments for uterine resuspension in a fashion similar to uterosacral vaginal cuff suspension. This study expands the challenge to the tradition of mandatory hysterectomy for uterine prolapse, a hysterectomy indication that, by itself, may be obsolete [6,7,8,10,11,12,13].…”

“…A postal questionnaire comparison of sacrospinous hysteropexy compared to cuff suspensions showed no difference in durability [12]. The only randomized prospective native tissue study comparing sacrospinous suspension in women randomized to uterine-preserving sacrospinous hysteropexy or vaginal hysterectomy with sacrospinous cuff suspension showed a slight durability advantage in the hysterectomy group at 1 year [13].…”

Pelvic Organ Prolapse: Planning for Surgery—Indications, Decision, Special Instruments, and Controversies

“…These authors reported a higher proportion of recurrent apical prolapse in the SSH group compared to TVH at 1 year: 27 % versus 3 %, which they attributed to a higher stage of POP. No statistical signifi cance was detected for QOL or functional outcomes between the two groups although the time to return to work for SSH group was shorter [ 37 ].…”