The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication

Abstract

Introduction and hypothesis The objective of this study is to evaluate cervical amputation with uterosacral ligament plication (modified Manchester) and compare it to vaginal hysterectomy with high uterosacral ligament plication procedure with special regard to the middle compartment. Methods Consecutive women with pelvic organ prolapse who underwent either vaginal hysterectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardised questionnaires (incontinence impact questionnaire, urogenital distress inventory, and defaecatory distress inventory). Results Between 2002 and 2007, 156 patients were included. Ninety-eight patients returned for a 1-year follow-up. In the modified Manchester group, we found no middle compartment recurrence versus two (4%) in the vaginal hysterectomy group. Anterior and posterior compartment prolapse recurrences (stage ≥2) were similar (approximately 50%). Considering operating time and blood loss, modified Manchester was more favourable. There was no difference in the pre-and postoperative subjective scores. The overall functional outcome was acceptable.Conclusions We found an excellent performance of both procedures regarding middle compartment recurrences.

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

“…Kohli reported 0% failure in 25 laparoscopic uterosacral hysteropexy patients and 3 (12%) recurrences in 25 vaginal hysterectomy patients, with essentially no recurrence of cystocele and rectocele [10]. Similarly, de Boer's group reported no recurrence in the cervical amputation-modified Manchester hysteropexy group, and 4% "middle compartment" recurrence in the hysterectomy group at 1 year, with no recurrence of severe cystocele or rectocele and approximately 50% recurrence of POP-Q stage 2 cystocele and rectocele, mostly asymptomatic [11]. By comparison, our hysteropexy and hysterectomy apex durabilities (approximating POP-Q points D and C, respectively) were similar to these uterosacral ligament suspension studies with 4% and 3.2% recurrence, respectively, also showing highest recurrence among cystoceles, at 6% in the hysterectomy and 13% in the hysteropexy group at 2 years (p00.31).…”

“…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].…”

“…The only data on intraperitoneal uterosacral suspensions compare laparoscopic uterosacral hysteropexy to vaginal hysterectomy-uterosacral cuff suspension, showing durability advantage in the hysteropexy group [10]. Uterosacral cuff suspension at time of vaginal hysterectomy demonstrated similar durability when compared to cervical amputation (modified Manchester) at 1-year follow-up; however, again, the techniques were not exact mimics [11]. A postal questionnaire comparison of sacrospinous hysteropexy compared to cuff suspensions showed no difference in durability [12].…”

Uterus Preserving Prolapse Repair: How Long does it Last?

“…Deciding to remove the uterus is a difficult process for many women. On the other hand, for many years, hysterectomy has been an integral part of POP treatment and a "standard" procedure for many urogynecologists [3]. The rationale for hysterectomy includes its advantages, like no need for further gynaecological follow-up, no risk of future uterine malignant disease and avoidance of difficulties in future pelvic surgery but most importantly, and at least theoretically, the lower risk of POP recurrence [19].…”

“…Traditionally, the management of POP included hysterectomy, either vaginal or abdominal, independently of the presence or absence of uterine disease and patients' wishes [2,3]. Recently, interest has been growing in uterus-preserving surgery [4].…”