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The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: a matched historical cohort study

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Abstract

Introduction and hypothesis

This study compares vaginal hysterectomy with uterosacral ligament suspension (VH) with the Manchester-Fothergill procedure (MP) for treating pelvic organ prolapse (POP) in the apical compartment.

Methods

Our matched historical cohort study is based on data from four Danish databases and the corresponding electronic medical records. Patients with POP surgically treated with VH (n = 295) or the MP (n = 295) in between 2010 and 2014 were matched for age and preoperative POP stage in the apical compartment. The main outcome was recurrent or de novo POP in any compartment. Secondary outcomes were recurrent or de novo POP in each compartment and complications.

Results

The risk of recurrent or de novo POP in any compartment was higher after VH (18.3%) compared with the MP (7.8%) (Hazard ratio, HR = 2.5, 95% confidence interval (CI): 1.3–4.8). Recurrence in the apical compartment occurred in 5.1% after VH vs. 0.3% after the MP (hazard ratio (HR) = 10.0, 95% confidence interval (CI) 1.3–78.1). In the anterior compartment, rates of recurrent or de novo POP were 11.2% after VH vs. 4.1% after the MP (HR = 3.5, 95% CI 1.4–8.7) and in the posterior compartment 12.9% vs. 4.7% (HR = 2.6, 95% CI 1.3–5.4), respectively. There were more perioperative complications (2.7 vs. 0%, p = 0.007) and postoperative intra-abdominal bleeding (2 vs. 0%, p = 0.03) after VH.

Conclusions

This study shows that the MP is superior to VH; if there is no other indication for hysterectomy, the MP should be preferred to VH for surgical treatment of POP in the apical compartment.

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Acknowledgements

The study was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation.

Data from the databases was kindly provided by the Danish Clinical Registries (RKKP). The authors thank Tobias Wirenfeldt Klausen, Rikke Kart Jacobsen and Berit Sejersen Larsen for their contributions with statistical support and typing of data.

Funding

Herlev and Gentofte University Hospital and the Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital.

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Authors and Affiliations

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

    Cæcilie Krogsgaard Tolstrup, Karen Ruben Husby, Gunnar Lose, Ulrik Schiøler Kesmodel & Niels Klarskov

  2. University of Copenhagen, Copenhagen, Denmark

    Cæcilie Krogsgaard Tolstrup, Karen Ruben Husby, Gunnar Lose, Ulrik Schiøler Kesmodel & Niels Klarskov

  3. Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark

    Tine Iskov Kopp & Petra Hall Viborg

Authors
  1. Cæcilie Krogsgaard Tolstrup
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  2. Karen Ruben Husby
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  3. Gunnar Lose
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  4. Tine Iskov Kopp
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  5. Petra Hall Viborg
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  6. Ulrik Schiøler Kesmodel
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  7. Niels Klarskov
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Corresponding author

Correspondence to Cæcilie Krogsgaard Tolstrup.

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Conflicts of interest

C.K. Tolstrup has, in relation to the study, received a research grant from the Nordic Urogynaecological Association (NUGA) and a travel grant from the Oticon Foundation, and has, outside the study, a conference fee and travel expenses paid by Astellas Pharma.

K.R. Husby received, in relation to the study, funding for conference participation from Tove Birthe Jensens Mindelegat and Fund of Danish Urogynaecological Society.

G. Lose has received consultation fees from Astellas and Contura.

T.I. Kopp, P.H. Viborg, and U.S. Kesmodel have nothing to disclose.

N. Klarskov has, outside the study, received personal fees from Astellas Pharma.

None of the mentioned funding sources had a role in design, conduct, analysis, or reporting of the study.

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Tolstrup, C.K., Husby, K.R., Lose, G. et al. The Manchester-Fothergill procedure versus vaginal hysterectomy with uterosacral ligament suspension: a matched historical cohort study. Int Urogynecol J 29, 431–440 (2018). https://doi.org/10.1007/s00192-017-3519-9

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  • DOI: https://doi.org/10.1007/s00192-017-3519-9

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