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Surgical management of pelvic organ prolapse and uterine descent in the Netherlands

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Abstract

Introduction and hypothesis

To evaluate current practice in the surgical treatment of uterine descent among members of the Dutch Urogynecological Society and to analyze possible trends in the surgical treatment of pelvic organ prolapse in the Netherlands during the last decade.

Methods

A questionnaire, including case scenarios, was sent to the members of the Dutch Urogynecological Society. Using a nationwide registry from the Netherlands, we assessed the number and type of surgical procedures performed for pelvic organ prolapse between 1997 and 2009.

Results

The response rate was 73%, with 161 questionnaires completed. Vaginal hysterectomy, sacrospinous hysteropexy, and the Manchester Fothergill procedure were the most frequently performed surgical interventions for uterine descent. In the case of lower stage uterine descent, uterus preservation was preferred, but in the case of higher stage there was wide variation. Two thirds of the respondents stated that in recent years they tended to save the uterus more often. The registered number of hospital admissions for uterine descent increased by 30% between 1997 and 2009 and the number of surgical procedures almost doubled. The number of vaginal hysterectomies performed because of uterine descent increased by only 15% in this period.

Conclusions

In the Netherlands, surgical policy in the case of uterine descent is very variable, with no clear preference for either hysterectomy or uterus preservation. There was a high increase in hospital admissions and pelvic organ prolapse procedures in the last decade. The number of vaginal hysterectomies performed because of uterine descent did not follow this change, which reflects a trend toward preserving the uterus.

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Conflicts of interest

Detollenaere RJ: none; den Boon J: incidental payment for lectures for Johnson and Johnson; Kluivers KB: none; Vierhout ME: member of the European Advisory board on OveractiveBladder, Astellas Europe; van Eijndhoven HWF: none.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Isala klinieken, PO Box 10500, 8000 GK, Zwolle, The Netherlands

    R. J. Detollenaere, J. den Boon & H. W. F. van Eijndhoven

  2. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    R. J. Detollenaere, K. B. Kluivers & M. E. Vierhout

Authors
  1. R. J. Detollenaere
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  2. J. den Boon
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  3. K. B. Kluivers
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  4. M. E. Vierhout
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  5. H. W. F. van Eijndhoven
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Corresponding author

Correspondence to R. J. Detollenaere.

Additional information

No ethical approval was obtained because this study is not subject to the Dutch Medical Research Involving Human Subjects Act (WMO). Completing a questionnaire on one occasion does not generally bring a study within the scope of the Act. Only if the questions are embarrassing (dealing with sexual behavior, mental well-being) or if the questionnaire is (very) long is ethical approval required.

Appendix

Appendix

Case scenarios

  1. Case 1

    A 40-year-old healthy woman visits her gynecologist because of pelvic organ prolapse. She has no past medical history. She reports stress urinary incontinence once a week. Attempts to reduce her complaints with PFMT and a pessary did not work out. Clinical examination shows a stage 3 anterior vaginal wall prolapse, a stage 2 uterine descent, and a stage 1 posterior vaginal wall prolapse. POP-Q: Aa +1 cm, Ba +2 cm, C 0 cm, GH 4 cm, PL 3 cm, TVL 8 cm, Ap −2 cm, Bp −2 cm, D −4 cm. When the prolapse is redressed there is no urinary incontinence. Because of her condition the patient wants a surgical correction.

    1. a.

      Which operative procedure do you prefer in treatment of the middle compartment of this patient?

      • Vaginal hysterectomy

      • Sacrospinous hysteropexy

      • Manchester–Fothergill repair

      • Hysteropexy by laparotomy

      • Laparoscopic hysteropexy

      • Posterior intravaginal sling

      • Colpocleisis

      • Other, which procedure?

    2. b.

      Would your procedure change if it was a stage 3 uterine descent?

    3. c.

      Could you further explain your answers?

  2. Case 2

    A 65-year-old woman visits her gynecologist because of pelvic organ prolapse. She has mild hypertension. She reports urge urinary incontinence once a month. Clinical examination shows a stage 3 vaginal wall prolapse, a stage 2 uterine descent, and a stage 1 posterior vaginal wall prolapse. POP-Q: Aa +1 cm, Ba +2 cm, C 0 cm, GH 4 cm, PL 3 cm, TVL 8 cm, Ap −2 cm, Bp −2 cm, D −4 cm. When the prolapse is redressed there is no urinary incontinence. Because of her condition the patient wants a surgical correction.

    1. a.

      Which operative procedure do you prefer in treatment of the middle compartment of this patient?

      • Vaginal hysterectomy

      • Sacrospinous hysteropexy

      • Manchester–Fothergill repair

      • Hysteropexy by laparotomy

      • Laparoscopic hysteropexy

      • Posterior intravaginal sling

      • Colpocleisis

      • Other, which procedure?

    2. b.

      Would your procedure change if it was a stage 3 uterine descent?

    3. c.

      Would your procedure change if it was an 80-year-old woman?

    4. d.

      Could you further explain your answers?

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Detollenaere, R.J., den Boon, J., Kluivers, K.B. et al. Surgical management of pelvic organ prolapse and uterine descent in the Netherlands. Int Urogynecol J 24, 781–788 (2013). https://doi.org/10.1007/s00192-012-1934-5

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  • DOI: https://doi.org/10.1007/s00192-012-1934-5

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