, Volume 14, Issue 5, pp 350-355
Date: 23 Sep 2003

Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms

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Abstract

One hundred and three women underwent sacrospinous hysteropexy (n=54) or vaginal hysterectomy with a vaginal vault suspension (n=49) for the management of descensus uteri. They were sent a postal questionnaire. Logistic regression analysis was used to obtain crude and adjusted odds ratios. Seventy-four (72%) women responded. The adjusted odds ratios for urge incontinence is 3.4 (1.0–12.3) and for overactive bladder 2.9 (0.5–16.9) greater after vaginal hysterectomy. The women recovered significantly more quickly after sacrospinous hysteropexy. There were no differences in anatomical outcome or recurrence rate. When performed to correct a descensus uteri of grade 2 or more we found that vaginal hysterectomy is associated with a three times higher risk for urge incontinence and overactive bladder symptoms. In addition, the women who underwent sacrospinous hysteropexy also reported a quicker recovery from surgery. Sacrospinous hysteropexy, therefore, appears to be promising for the correction of descensus uteri.

Editorial Comment: This is the first study looking at urinary symptoms relating to whether or not the uterus was preserved at the time of prolapse surgery. The authors should be commended for using an excellent tool for identifying symptoms and for the 75% response rate to their questionnaire. However, it is very difficult to make a statement that leaving the uterus in place definitely has an impact on preventing postoperative overactive bladder symptoms, particularly in view of the increased risk of cervical cancer and potentially endometrial cancer that accompanies leaving the uterus in place. Also, more long-term follow-up is necessary to determine how many of the women in the hysterectomy group will eventually go on to hysterectomy.