Pelvic organ prolapse and uterine preservation: A case control study (POP-UP study)

Abstract

Background: Abdominal and laparoscopic sacro-colpopexy (LSC) is the preferred surgical option for the management of a symptomatic apical pelvic organ prolapse (POP). Women who have their uterus, and for whom an LSC is indicated, can have a laparoscopic sacro-hysteropexy (LSH), a laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH+LSC) or a total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH+LSC). The main aim of this study was to compare clinical and patient reported outcomes of uterine sparing versus concomitant hysterectomy LSC procedures. Methods: A retrospective analysis of clinical, imaging and patient reported outcomes at baseline, 3 and 12 months after LSH (cases) versus either LSCH+LSC or TLH+LSC between January 2015 and January 2019 in a tertiary referral urogynecology center in Pilsen, the Czech Republic. Results. In total, 294 women were included in this analysis (LSH n = 43, LSCH+LSC n = 208 and TLH+LSC n = 43). There were no differences in the rates of perioperative injuries and complications. Operating time and blood loss were higher in the concomitant hysterectomy compared to the uterine sparing group but this was only significant when comparing LSH to TLH+LSC (p = 0.048). There were no statistically significant differences in any of the clinical or patient reported outcomes except for a significantly lower anterior compartment failure rate (p= 0.017) and higher optimal mesh placement rate at 12 months in women who had concomitant hysterectomy procedures (p = 0.006).Conclusion. LSH is associated with shorter operative time and intraoperative blood loss; nevertheless, higher rates of anterior compartment failures and suboptimal mesh placement.