Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques
Introduction and hypothesis
Uterine prolapse is a common diagnosis. Today no consensus exists on which operation technique is ideal to treat apical prolapse. Vaginal hysterectomy (VH) with suspension of the vaginal cuff is the most frequently used. The popularity of uterus-preserving techniques is increasing. The aim of this study was to compare the efficiency of vaginal native tissue operations to treat primary apical prolapse, evaluated on risk of relapse surgery.
Data were obtained from the Danish National Patient Registry (NPR), which contains all operations performed in Denmark. Patients operated on for primary apical prolapse in Denmark 2010–2016 were included and followed until 2017. Clinical data were obtained from the Danish Urogynecological Database. Patients who were previously hysterectomized or operated on for prolapse in the apical compartment were excluded. Data were analyzed using Cox proportional hazard regression analysis and adjusted for age, BMI, smoking, preoperative prolapse stage and previous POP operations.
In total, 7247 operations were included. The hazard ratio (HR) for relapse operation in the apical compartment was significantly higher after sacrospinous hysteropexy (SH) compared with the Manchester-Fothergill procedure (MP) [40.2 confidence interval (CI) 21.6–74.7] and VH (8.5 CI: 6.0–12.1). Likewise, the HR was higher in the anterior compartment after SH compared with MP (4.3 CI: 2.9–6.4) and VH (2.8 CI: 2.0–4.0). No convincing difference was found in the posterior compartment. The 5-year reoperation rates were 30%, 7% and 11% after SH, MP, and VH, respectively.
Sacrospinous hysteropexy has exceedingly high numbers of reoperations due to prolapse recurrence.
KeywordsPelvic organ prolapse (POP) Apical prolapse Manchester-Fothergill procedure Vaginal hysterectomy Sacrospinous hysteropexy
The American Society of Anesthesiologists
Body mass index
The Danish Urogynecological Database
Compliance with ethical standards
Conflict of interest
KR Husby, MD Larsen and G Lose have no disclosures. N Klarskov has received funding from Astellas Pharma and Contura outside the study.
- 3.Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010: CD004014. https://doi.org/10.1002/14651858.CD004014.pub4.
- 8.Danish Urogynecological database, available online at: http://www.dugabase.dk/. Accessed December 12, 2017.
- 10.Husby KR, Lose G, Klarskov N. Trends in apical prolapse surgery between 2010 and 2016 in Denmark. 2018. https://doi.org/10.1007/s00192-018-3852-7.
- 15.Meriwether K V, Balk EM, Antosh DD, et al. Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines. Int Urogynecol J. 2019.Google Scholar