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Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines

  • Kate V. MeriwetherEmail author
  • Ethan M. Balk
  • Danielle D. Antosh
  • Cedric K. Olivera
  • Shunaha Kim-Fine
  • Miles Murphy
  • Cara L. Grimes
  • Ambereen Sleemi
  • Ruchira Singh
  • Alexis A. Dieter
  • Catrina C. Crisp
  • David D. Rahn
Review Article

Abstract

Introduction and hypothesis

We aimed to systematically review the literature on pelvic organ prolapse (POP) surgery with uterine preservation (hysteropexy). We hypothesized that different hysteropexy surgeries would have similar POP outcomes but varying adverse event (AE) rates.

Methods

MEDLINE, Cochrane, and clinicaltrials.gov databases were reviewed from inception to January 2018 for comparative (any size) and single-arm studies (n ≥ 50) involving hysteropexy. Studies were extracted for participant characteristics, interventions, comparators, outcomes, and AEs and assessed for methodological quality.

Results

We identified 99 eligible studies: 53 comparing hysteropexy to POP surgery with hysterectomy, 42 single-arm studies on hysteropexy, and four studies comparing stage ≥2 hysteropexy types. Data on POP outcomes were heterogeneous and usually from <3 years of follow-up. Repeat surgery prevalence for POP after hysteropexy varied widely (0–29%) but was similar among hysteropexy types. When comparing sacrohysteropexy routes, the laparoscopic approach had lower recurrent prolapse symptoms [odds ratio (OR) 0.18, 95% confidence interval (CI) 0.07–0.46), urinary retention (OR 0.05, 95% CI 0.003–0.83), and blood loss (difference −104 ml, 95% CI −145 to −63 ml) than open sacrohysteropexy. Laparoscopic sacrohysteropexy had longer operative times than vaginal mesh hysteropexy (difference 119 min, 95% CI 102–136 min). Most commonly reported AEs included mesh exposure (0–39%), urinary retention (0–80%), and sexual dysfunction (0–48%).

Conclusions

Hysteropexies have a wide range of POP recurrence and AEs; little data exist directly comparing different hysteropexy types. Therefore, for women choosing uterine preservation, surgeons should counsel them on outcomes and risks particular to the specific hysteropexy type planned.

Keywords

Hysteropexy Prolapse Surgery Uterine preservation Systematic review Risks 

Notes

Acknowledgments

This work is supported by the Society of Gynecologic Surgeons (SGS), whose members comprise the Systematic Review Group (SRG) performing this review. SGS supports the SRG with provision of meeting space and oversight, and aids in the public dissemination of study findings to its members. SGS funds Dr. Balk as a paid methodological consultant.

Compliance with ethical standards

Conflicts of interest

KVM is a textbook editor for Elsevier publications and has not yet received any royalties for that publication. The other authors have no conflicts to disclose.

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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Kate V. Meriwether
    • 1
    Email author
  • Ethan M. Balk
    • 2
  • Danielle D. Antosh
    • 3
  • Cedric K. Olivera
    • 4
  • Shunaha Kim-Fine
    • 5
  • Miles Murphy
    • 6
  • Cara L. Grimes
    • 7
  • Ambereen Sleemi
    • 8
  • Ruchira Singh
    • 9
  • Alexis A. Dieter
    • 10
  • Catrina C. Crisp
    • 11
  • David D. Rahn
    • 12
  1. 1.Department of Obstetrics and GynecologyUniversity of LouisvilleLouisvilleUSA
  2. 2.Center for Evidence Synthesis in HealthBrown University School of Public HealthProvidenceUSA
  3. 3.Department of Obstetrics and GynecologyHouston Methodist HospitalHoustonUSA
  4. 4.Department of Obstetrics and GynecologyNew York UniversityNew YorkUSA
  5. 5.Department of Obstetrics and GynecologyUniversity of CalgaryCalgaryCanada
  6. 6.The Institute for Female Pelvic Medicine & Reconstructive SurgeryNorth WalesUSA
  7. 7.Department of Obstetrics and GynecologyNew York Medical CollegeValhallaUSA
  8. 8.International Medical ResponseBrooklynUSA
  9. 9.Department of Obstetrics and GynecologyUniversity of Florida HealthJacksonvilleUSA
  10. 10.Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillUSA
  11. 11.Division of Female Pelvic Medicine and Reconstructive SurgeryTriHealthCincinnatiUSA
  12. 12.Department of Obstetrics and GynecologyUniversity of Texas SouthwesternDallasUSA

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