Abstract
The aim of this study was to evaluate whether hysterectomy or the use of graft is necessary for the reconstructive surgery for uterine prolapse. One hundred sixty-eight patients were categorized into the 3 groups: group I, abdominosacral colpopexy with mesh and hysterectomy (n = 63); group II, abdominosacral uteropexy with mesh (n = 35); group III, abdominal uterosacrocardinal colpopexy and hysterectomy (n = 70). Perioperative and postoperative complications, functional outcomes, and anatomical recurrences were assessed. The median follow-up was 36 months in all surgery groups. In the complication rates and functional outcomes, no difference was noted, except for operation time (longer in group I, p = 0.001) and hemoglobin loss (greater in group II, p = 0.002). There was a significant difference in the cumulative anatomical cure rates (p < 0.0001). The risk of recurrence in group III was 6.2 times higher than in group I. In conclusion, the use of graft, rather than hysterectomy, might be necessary for the reconstructive surgery for uterine prolapse.
Similar content being viewed by others
References
Thakar R, Stanton S (2002) Management of genital prolapse. BMJ 324:1258–1262
Bonney V (1934) The principles that should underlie all operation for prolapse. J Obstet Gynaecol Br Emp 41:669–683
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506
Nichols DH (1982) Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol 142:901–904
Cruikshank SH, Muniz M (2003) Outcome study: a comparison of cure rates in 695 patients undergoing sacrospinous ligament fixation alone and with other site-specific procedure: a 16-year study. Am J Obstet Gynecol 188:1509–1515
Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175:1418–1422
Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190:20–26
Bump R, Bo K, Brubaker L (1996) The International Continence Society Committee on Standardization of Terminology, Subcomittee on Pelvic Organ Prolapse and Pelvic Floor Dysfunction: the standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17
Marana HR, Andrade JM, Marana RR (1999) Vaginal hysterectomy for correcting genital prolapse. J Reprod Med 44:529–534
Petros P (2007) The anatomy and dynamics of pelvic floor function and dysfunction. In: Petros P (ed) The female pelvic floor, 2nd edn. Springer, Berlin Heidelberg New York, pp 14–50
Nesbitt REL (1989) Uterine preservation in the surgical management of genuine stress urinary incontinence associated with uterovaginal prolapse. Surg Gynecol Obstet 168:143–149
DeLancey JO (1993) Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol 36:897–909
Nichols DH (1993) Massive eversion of the vagina. In: Nichols DH (ed) Gynecologic and obstetric surgery. Mosby, St. Louis, pp 431–464
Thomas AG, Brodman ML, Dottino PR, Bodian C, Friedman F Jr, Bogursky E (1995) Manchester procedure vs. vaginal hysteredctomy for uterine prolapse: a comparison. J Reprod Med 40:299–304
Kovac SR, Cruikshank SH (1993) Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol 168:1778–1783
van Brummen HJ, van de Pol G, Aalders CIM, Heintz AP, van der Vaart CH (2003) Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J Pelvic Floor Dysfunct 14:350–355
Hefni M, El-Toucky T, Bhaumik J, Katsimanis E (2003) Sacrospinous cervico-colpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol 188:645–650
Costantini E, Mearini L, Bini V, Zucchi A, Mearini E, Porena M et al (2005) Uterus preservation in surgical correction of urogenital prolapse. Eur Urol 48:642–649
Banu LF (1997) Synthetic sling for genital prolapse in young women. Int J Gynaecol Obstet 57:57–64
Maher CF, Cary MP, Slack MP, Murray CJ, Milligan M, Schluter P (2001) Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J Pelvic Floor Dysfunct 12:381–385
Nieminen K, Huhtala H, Heinonen PK (2003) Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation. Acta Obstet Gynecol Scand 82:471–478
Wingo PA, Huezo CM, Rubin GL, Ory HW, Peterson HB (1985) The mortality risk associated with hysterectomy. Am J Obstet Gynecol 152:803–808
Brown JS, Sawaga G, Thom DH, Grady D (2000) Hysterectomy and urinary incontinence: a systematic review. Lancet 356:535–539
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jeon, M.J., Jung, H.J., Choi, H.J. et al. Is hysterectomy or the use of graft necessary for the reconstructive surgery for uterine prolapse?. Int Urogynecol J 19, 351–355 (2008). https://doi.org/10.1007/s00192-007-0442-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-007-0442-5