Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis
- 782 Downloads
Introduction and hypothesis
The efficacy and safety of removing or preserving the uterus during reconstructive pelvic surgery is a matter of debate.
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.
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.
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.
KeywordsPelvic organ prolapse Hysterectomy Hysteropreservation Uterine preservation Meta-analyses Systematic review
We thank Vinícius Fernando Calsavara who helped with the statistical analyses.
Compliance with ethical standards
Conflicts of interest
- 7.Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339:332–9.Google Scholar
- 9.Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration; 2011. www.cochrane-handbook.org. Accessed 23 Jul 2017.
- 19.Jeng CJ, Yang YC, Tzeng CR, Shen J, Wang LR. Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse. J Rep Med. 2005;50(9):669–74.Google Scholar
- 21.de Boer TA, Milani AL, Kluivers KB, Withagen MI, Vierhout ME. The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication. Int Urogynecol J. 2009;20(11):1313–9.CrossRefGoogle Scholar
- 27.Marschalek J, Trofaier ML, Yerlikaya G, et al. Anatomic outcomes after pelvic organ prolapse surgery comparing uterine preservation with hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2014;183:33–6.Google Scholar
- 29.Iliev VN, Andonova IT. Uterus preserving vaginal surgery versus vaginal hysterectomy for correction of female pelvic organ prolapse. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2014;35(1):243–7.Google Scholar