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International Urogynecology Journal

, Volume 28, Issue 11, pp 1617–1630 | Cite as

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

  • Sofia Andrade de Oliveira
  • Marcelo C. M. Fonseca
  • Maria A. T. Bortolini
  • Manoel J. B. C. Girão
  • Matheus T. Roque
  • Rodrigo A. Castro
Review Article

Abstract

Introduction and hypothesis

The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate.

Methods

We performed a systematic review and meta-analysis of studies that compared hysteropreservation and hysterectomy in the management of uterine prolapse. PubMed, Medline, SciELO and LILACS databases were searched from inception until January 2017. We selected only randomized controlled trials and observational cohort prospective comparative studies. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were: operative time, blood loss, visceral injury, voiding dysfunction, duration of catheterization, length of hospital stay, mesh exposure, dyspareunia, malignant neoplasia and quality of life.

Results

Eleven studies (six randomized and five non-randomized) were included involving 910 patients (462 in the hysteropreservation group and 448 in the hysterectomy group). Pooled data including all surgical techniques showed no difference between the groups regarding recurrence of uterine prolapse (RR 1.65, 95% CI 0.88–3.10; p = 0.12), but the risk of recurrence following hysterectomy was lower when the vaginal route was used with native tissue repair (RR 10.61; 95% CI 1.26–88.94; p = 0.03). Hysterectomy was associated with a lower reoperation rate for any prolapse compartment than hysteropreservation (RR 2.05; 95% CI 1.13–3.74; p = 0.02). Hysteropreservation was associated with a shorter operative time (mean difference −12.43 min; 95% CI −14.11 to −10.74 ; p < 0.00001) and less blood loss (mean difference −60.42 ml; 95% CI −71.31 to −49.53 ml; p < 0.00001). Other variables were similar between the groups.

Conclusions

Overall, the rate of recurrence of uterine prolapse was not lower but the rate of reoperation for prolapse was lower following hysterectomy, while operative time was shorter and blood loss was less with hysteropreservation. The limitations of this analysis were the inclusion of nonrandomized studies and the variety of surgical techniques. The results should be interpreted with caution due to potential biases.

Keywords

Pelvic organ prolapse Hysterectomy Hysteropreservation Uterine preservation Meta-analyses Systematic review 

Notes

Acknowledgements

We thank Vinícius Fernando Calsavara who helped with the statistical analyses.

Compliance with ethical standards

Funding

None.

Conflicts of interest

None.

Supplementary material

192_2017_3433_MOESM1_ESM.docx (129 kb)
ESM 1 (DOCX 129 kb).

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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  • Sofia Andrade de Oliveira
    • 1
    • 2
  • Marcelo C. M. Fonseca
    • 1
  • Maria A. T. Bortolini
    • 1
  • Manoel J. B. C. Girão
    • 1
  • Matheus T. Roque
    • 3
  • Rodrigo A. Castro
    • 1
  1. 1.Department of GynecologyFederal University of São PauloSão PauloBrazil
  2. 2.Departament of Life ScienciesBahia State UniversitySalvadorBrazil
  3. 3.Department of SurgeryFederal University of Minas GeraisBelo HorizonteBrazil

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