Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery: A systematic review and meta‐analysis

• Published in: International journal of gynecology and obstetrics 2024-07, Vol.166 (1), p.173-189
• Main Authors: Porcari, Irene, Zorzato, Pier Carlo, Bosco, Mariachiara, Garzon, Simone, Magni, Francesca, Salvatore, Stefano, Franchi, Massimo P., Uccella, Stefano
• Format: Article
• Language: English
• Subjects: Female; Humans; Hysterectomy - adverse effects; Hysterectomy - methods; hysteropexy; laparoscopic hysterectomy; minimally invasive surgery; Operative Time; Organ Sparing Treatments - methods; Pelvic Organ Prolapse - surgery; Postoperative Complications - epidemiology; Reoperation - statistics & numerical data; sacral cervicopexy; sacrocolpopexy; sacrohysteropexy; uterine prolapse; Uterus - surgery; vaginal hysterectomy
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1002/ijgo.15343

Background Previous reviews on hysterectomy versus uterine‐sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned. Objectives To provide up‐to‐date evidence by examining only studies investigating techniques currently in use for POP repair. Search Strategy MEDLINE and Embase databases were searched from inception to January 2023. Selection Criteria We included randomized and non‐randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded. Data Collection and Analysis A random effect meta‐analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI). Main Results Thirty‐eight studies were included. Hysterectomy and uterine‐sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74–1.17), intraoperative major (OR 1.34; 95% CI 0.79–2.26) and minor (OR 1.38; 95% CI 0.79–2.4) complications, postoperative major (OR 1.42; 95% CI 0.85–2.37) and minor (OR 1.18; 95% CI 0.9–1.53) complications, and objective (OR 1.38; 95% CI 0.92–2.07) or subjective (OR 1.23; 95% CI 0.8–1.88) success. Uterine preservation was associated with a shorter operative time (−22.7 min; 95% CI –16.92 to −28.51 min), shorter hospital stay (−0.35 days, 95% CI –0.04 to −0.65 days), and less blood loss (−61.7 mL; 95% CI –31.3 to −92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups. Conclusions No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors. Synopsis In women with indication for surgical management of pelvic organ prolapse, the decision to preserve or remove the uterus should be tailored on individual factors.