Comment on “Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis”

Sir,

We read with great interest the review article by de Oliveira et al. entitled “Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis” [1]. First, we congratulate the authors on a well-conducted systematic review on this very pertinent topic. Broadly, the results are in agreement with those of other systematic reviews comparing uterus-preserving prolapse repair procedures with vaginal hysterectomy [2].

We wonder why the authors did not include the large randomized controlled trial by Detollenaere et al. of vaginal sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension [3]. This randomized controlled trial with over 100 women in each arm would meet the inclusion criteria of the current review and add strength to the evidence. Inclusion of data from this study in the current meta-analysis for the subgroup ‘vaginal hysteropexy vs. vaginal hysterectomy – no mesh’ would change the relative risk for recurrence from 3.70 (95% confidence interval 1.11–12.37) to 1.41 (95% confidence interval 0.21–9.30). This result, showing no difference in recurrence rates between the two procedure, would align with the results of our meta-analysis comparing sacrospinous hysteropexy and vaginal hysterectomy [4].