Uterus preservation in pelvic organ prolapse surgery

Abstract

Attitudes to sexuality and the psychological value of reproductive organs have changed in Western countries over the last few decades. Nevertheless, repair of pelvic support defects with concomitant hysterectomy is still considered the standard treatment for pelvic organ prolapse. Over the last 10 years, however, interest has been growing in uterus-sparing surgery, which can be divided into vaginal, abdominal, and laparoscopic procedures. The majority of studies on uterus-sparing surgery, with the exception of abdominal techniques, report few cases with short follow-up. Sacrospinous hysteropexy is the most studied vaginal technique for uterus preservation and favorable results have been demonstrated, although the majority of studies are flawed by selection and information bias, short follow-up and lack of adequate control groups. Abdominal and laparoscopic procedures are promising, providing similar functional and anatomical results to hysterectomy and sacrocolpopexy. Consensus is growing that the uterus can be preserved at the time of pelvic reconstructive surgery in appropriately selected women who desire it. The results of comparison trials and prospective studies confirm that uterus-sparing surgery is feasible and is associated with similar outcomes to hysterectomy, as well as shorter operating times. Surgeons should be ready to respond to the wishes of female patients who want to preserve vaginal function and the uterus.

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

“…Most retrospective studies reported anatomical success rates between 74 and 93 % with short-to intermediate-term follow-up [ 36 ]. A recent multicenter randomized control trial by Dietz et al compared TVH ( n = 31) with unilateral SSH ( n = 35) for stage 2-4 uterine prolapse with an intention to treat analysis.…”

“…Failure rates are estimated between 0 and 22 % and mesh erosion between 0 and 4.1 % [ 36 ]. However, most of the data for subjective and objective outcomes for these prolapse procedures are from uncontrolled retrospective case series.…”

Sacrohysteropexy followed by successful pregnancy and eventual reoperation for prolapse

“…Traditionally, uterovaginal prolapse is surgically treated with a hysterectomy combined with a pelvic support repair [1,2]. Future fertility desires and patient preference for uterine preservation have caused surgeons to develop techniques that allow for uterine conservation.…”

“…Future fertility desires and patient preference for uterine preservation have caused surgeons to develop techniques that allow for uterine conservation. Although there are a multitude of uterine-sparing prolapse repairs in the medical literature, there has been very little published on subsequent pregnancy and long-term success following such a repair [1,3].…”

Urgency, Detrusor Overactivity and Posterior Vault Prolapse in Women Who Underwent Pelvic Organ Prolapse Repair

“…However, POP repair often results in improvement in urgency and lower urinary tract symptoms (LUTS) [1,2]: 82-84% of the patients with severe urogenital prolapse who underwent integral pelvic floor reconstruction improved their LUTS [3,4,5,6]. …”