International Urogynecology Journal

, Volume 14, Issue 5, pp 350–355

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

  • H. J. van Brummen
  • G. van de Pol
  • C. I. M. Aalders
  • A. P. M. Heintz
  • C. H. van der Vaart
Original Article


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.


Correction of descensus uteri Micturition symptoms Sacrospinous hysteropexy Vaginal hysterectomy. 


  1. 1.
    SIG Zorg-informatie, Utrecht, Landelijke Medische Registratie 1995–1999, leeftijdscategorie 15 jaar en ouder. SIG Zorginformatie 2002Google Scholar
  2. 2.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506CrossRefPubMedGoogle Scholar
  3. 3.
    Brown JS, Sawaya G, Thom DH, Grady D (2000) Hysterectomy and urinary incontinence: a systematic review. Lancet 356:535–539CrossRefPubMedGoogle Scholar
  4. 4.
    Kuh D, Cardozo L, Hardy R (1999) Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol CommunHealth 53:453–458Google Scholar
  5. 5.
    van der Vaart CH, van der Bom JC, de Leeuw JRJ, Roovers JPWR, Heintz APM (2002) The contribution of hysterectomy to the occurence of urge- and stress urinary incontinence symptoms. Br J Obstet Gynaecol 109:149–154Google Scholar
  6. 6.
    Smith PH, Ballantyne B (1968) The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery. Br J Surg 55:929–933PubMedGoogle Scholar
  7. 7.
    Carey MP, Slack MC (1994) Transvaginal sacrospinous colpopexy for vault and marked uterovaginal prolapse. Br J Obstet Gynaecol 101:536–540PubMedGoogle Scholar
  8. 8.
    Goldberg RP, Tomezsko JE, Winkler HA, Koduri S, Culligan PJ, Sand PK (2001) Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation. Obstet Gynecol 98:199–204CrossRefPubMedGoogle Scholar
  9. 9.
    Kovac SR, Cruikshank SH (1993) Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol 168:1778–1783PubMedGoogle Scholar
  10. 10.
    Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P (2001) Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J 12:381–384CrossRefGoogle Scholar
  11. 11.
    Morley GW (1996) Treatment of uterine and vaginal prolapse. Clin Obstet Gynecol 39:959–969CrossRefPubMedGoogle Scholar
  12. 12.
    Nichols DH (1982) Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol 142:901–904PubMedGoogle Scholar
  13. 13.
    Ozcan U, Gungor T, Ekin M, Eken S (1999) Sacrospinous fixation for the prolapsed vaginal vault. Gynecol Obstet Invest 47:65–68CrossRefPubMedGoogle Scholar
  14. 14.
    Richardson DA, Scotti RJ, Ostergard DR (1989) Surgical management of uterine prolapse in young women. J Reprod Med 34:388–392PubMedGoogle Scholar
  15. 15.
    Sze EH, Karram MM (1997) Transvaginal repair of vault prolapse: a review. Obstet Gynecol 89:466–475CrossRefPubMedGoogle Scholar
  16. 16.
    Baden WF, Walker TA (1972) Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 15):1048–1054PubMedGoogle Scholar
  17. 17.
    Schumaker SA, Wyman JF, Uebersax JS, Clish D, Fantl JA (1994) Health related quality of life measures for women with urinary incontinence: The Urogenital Distress Inventory and the Incontinence Impact Questionnaire. Qual Life Res 3:291–306PubMedGoogle Scholar
  18. 18.
    Vaart van der CH, de Leeuw JRJ, Roovers JPWR, Heintz APM (2003) Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 22(2): 97–104Google Scholar
  19. 19.
    Abrams P, Cardozo L, Fall M et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 187:116–126CrossRefPubMedGoogle Scholar
  20. 20.
    Dorsey JH, Steinberg EP, Holtz PM (1995) Clinical indications for hysterectomy route: patient characteristics or physician preference? Am J Obstet Gynecol 173:1452–1460PubMedGoogle Scholar
  21. 21.
    Kuh D, Cardozo L, Hardy R (1999) Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Commun Health 53:453–458Google Scholar
  22. 22.
    Moller LA, Lose G, Jorgensen T (2000) The prevalence and bothersomeness of lower urinary tract symptoms in women 40–60 years of age. Acta Obstet Gynecol Scand 79:298–305CrossRefPubMedGoogle Scholar
  23. 23.
    Ryhammer AM, Laurberg S, Djurhuus JC, Hermann AP (1998) No relationship between subjective assessment of urinary incontinence and pad test weight gain in a random population sample of menopausal women. J Urol 159:800–803PubMedGoogle Scholar
  24. 24.
    Wyman JF, Choi SC, Harkins SW, Wilson MS, Fantl JA (1998) The urinary diary in evaluation of incontinent women: a test-retest analysis. Obstet Gynecol 71:812–817Google Scholar
  25. 25.
    Abrams P, Cardozo L, Fall M et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178CrossRefPubMedGoogle Scholar
  26. 26.
    Overactive Bladder and Its Treatments Consensus Conference. London, United Kingdom, 4July 1999. Urology 2000; 55:1–84Google Scholar
  27. 27.
    Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766CrossRefPubMedGoogle Scholar
  28. 28.
    Bonney V (1934) The principles that should underlie all operations for prolapse. J Obstet Gynaecol Br Emp 41:669–683Google Scholar

Copyright information

© International Urogynecological Association 2003

Authors and Affiliations

  • H. J. van Brummen
    • 1
  • G. van de Pol
    • 2
  • C. I. M. Aalders
    • 2
  • A. P. M. Heintz
    • 1
  • C. H. van der Vaart
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Obstetrics and GynecologyRijnstate HospitalArnhemThe Netherlands

Personalised recommendations