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The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review

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Abstract

Introduction and hypothesis

Uterine prolapse is a common health problem and the number of surgical procedures is increasing. No consensus regarding the surgical strategy for repair of uterine prolapse exists. Vaginal hysterectomy (VH) is the preferred surgical procedure worldwide, but uterus-preserving alternatives including the Manchester procedure (MP) are available. The objective was to evaluate if VH and the MP are equally efficient treatments for uterine prolapse with regard to anatomical and symptomatic outcome, quality of life score, functional outcome, re-operation and conservative re-intervention rate, complications and operative outcomes.

Methods

We systematically searched Embase, PubMed, the Cochrane databases, Clinicaltrials and Clinical trials register using the MeSh terms “uterine prolapse”, “uterus prolapse”, “vaginal prolapse” “pelvic organ prolapse”, “prolapsed uterus”, “Manchester procedure” and “vaginal hysterectomy”. No limitations regarding language, study design or methodology were applied. In total, nine studies published from 1966 to 2014 comparing the MP to VH were included.

Results

The anatomical recurrence rate for the middle compartment was 4–7 % after VH, whereas recurrence was very rare after the MP. The re-operation rate because of symptomatic recurrence was higher after VH (9–13.1 %) compared with MP (3.3–9.5 %) and more patients needed conservative re-intervention (14–15 %) than after MP (10–11 %). After VH, postoperative bleeding and blood loss tended to be greater, bladder lesions and infections more frequent and the operating time longer.

Conclusions

This review is in favour of the MP, which seems to be an efficient and safe treatment for uterine prolapse. We suggest that the MP might be considered a durable alternative to VH in uterine prolapse repair.

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Acknowledgements

We gratefully acknowledge doctor Svetlana Rygaard Nielsen for translating the Russian study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Herlev & Gentofte University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Cæcilie Krogsgaard Tolstrup

  2. Department of Obstetrics and Gynecology, Herlev & Gentofte University Hospital and Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Gunnar Lose & Niels Klarskov

Authors
  1. Cæcilie Krogsgaard Tolstrup
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  2. Gunnar Lose
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  3. Niels Klarskov
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Corresponding author

Correspondence to Cæcilie Krogsgaard Tolstrup.

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Conflicts of interest

CK Tolstrup received travel expenses and conference fees for the EUGA Annual Congress Leading Lights 2015 from by Astellas Pharma; Gunnar Lose received research grants from Astellas Pharma and consultant fees from Contura; Niels Klarskov received research grants from Astellas Pharma. None of the other authors received external funding for the study.

Authors’ contributions

CK Tolstrup: protocol development, data collection, data analysis, manuscript writing/editing.

G Lose: protocol development, manuscript editing.

N Klarskov: protocol development, data analysis, manuscript editing.

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Tolstrup, C.K., Lose, G. & Klarskov, N. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review. Int Urogynecol J 28, 33–40 (2017). https://doi.org/10.1007/s00192-016-3100-y

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  • DOI: https://doi.org/10.1007/s00192-016-3100-y

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