Anatomic outcomes after pelvic-organ-prolapse surgery—comparing uterine preservation with hysterectomy

• Published in: European journal of obstetrics & gynecology and reproductive biology 2014-12, Vol.183, p.33-36
• Main Authors: Marschalek, Julian, Trofaier, Marie-Louise, Yerlikaya, Guelen, Hanzal, Engelbert, Koelbl, Heinz, Ott, Johannes, Umek, Wolfgang
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Humans; Hysterectomy; Hysterectomy, Vaginal - methods; Logistic Models; Middle Aged; Natural orifice surgery; Obstetrics and Gynecology; Organ preservation; Organ Sparing Treatments - methods; Pelvic organ prolapse; Pelvic Organ Prolapse - surgery; Recurrence; Retrospective Studies; Risk Factors; Sacrospinous ligament fixation; Treatment Outcome; Urinary Incontinence - epidemiology; Uterus - physiology; Uterus - surgery
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2014.10.011

Abstract Objective Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11–19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses. Study design In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u -test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse. Results Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90 min; p = 0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse ( p > 0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p = 0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery. Conclusion Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses.