Skip to main content

Advertisement

SpringerLink
Log in

Time-frame comparison of hystero-preservation in the surgical treatment of uterine prolapse: a population-based nation-wide follow-up descriptive study, 2006–2013 versus 1997–2005

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

The purpose of our study was to describe the surgical trend and time-frame comparison between 1997–2005 (1stperiod) and 2006–2013 (2nd period) of hystero-preservation for uterine prolapse, based upon a nationwide population-based National Health Insurance (NHI) claim data in Taiwan.

Methods

Women, who underwent primary surgeries for uterine prolapse, either uterine suspension with hystero-preservation or hysterectomy during 1997–2013, were identified from National Health Insurance Research Database (NHIRD).We analyzed the related variables including surgical types (hystero-preservation or hysterectomy), patient age and concomitant anti-incontinence surgery, surgeon age, gender, and service volume; and hospital accreditation level, and service volume.

Results

We identified a total of 46,968 inpatients, 6629 (14.11%) hystero-preservation group, and 40,339 (85.89%) hysterectomy group. Hystero-preservation significantly increased during the 17 year follow-up study period (1997 to 2013) (P value =0.0147). The overall surgeries for uterine prolapse increased among patients ≥70 years, with concomitant anti-incontinence surgery, surgeons ≥45 years, high volume surgeons, and hospitals. Multiple logistic regression revealed hysterectomy was less used in 2nd period (OR 0.45, 95%, confidence interval (CI) 0.43–0.48). Hysterectomy was more often used in patient aged ≥50 years, surgeon aged ≥45 years, and low volume hospitals. In case of concomitant anti-incontinence surgery (OR 0.48, CI 0.45–0.52), high volume surgeons (more than 30 surgeries) and hospitals (more than 73 surgeries) hystero-preservation was more often used.

Conclusions

Time-frames, younger patients, concomitant anti-incontinence surgery, younger surgeons, and high volume surgeons and hospitals increase hystero-preservation for uterine prolapse. Surgeons and hospitals should be ready to respond to the wishes of female patients who want to preserve the uterus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the women's health initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.

    Article  PubMed  Google Scholar 

  2. de Oliveira SA, Fonseca MCM, Bortolini MAT, Girao M, Roque MT, Castro RA. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis. Int Urogynecol J. 2017;28(11):1617–30.

    Article  PubMed  Google Scholar 

  3. Kurkijarvi K, Aaltonen R, Gissler M, Makinen J. Pelvic organ prolapse surgery in Finland from 1987 to 2009: a national register based study. Eur J Obstet Gynecol Reprod Biol. 2017;214:71–7.

    Article  PubMed  Google Scholar 

  4. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189:372–7.

    Article  PubMed  Google Scholar 

  5. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Blandon RE, Bharucha AE, Melton LJ 3rd, et al. Incidence of pelvic floor repair after hysterectomy: a population-based cohort study. Am J Obstet Gynecol. 2007;197(6):664 e1–7.

    Article  Google Scholar 

  7. Wu MP, Long CY, Huang KH, Chu CC, Liang CC, Tang CH. Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study. Int Urogynecol J. 2012;23(7):865–72.

    Article  PubMed  Google Scholar 

  8. Wu MP, Wu CJ, Weng SF. The choice of reoperation after primary surgeries for uterine prolapse: a nationwide study. Gynecol Minim Invasive Ther. 2015;4(4):120–5.

    Article  Google Scholar 

  9. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. The Cochrane database of systematic reviews. 2016;11:CD004014.

    PubMed  Google Scholar 

  10. Anglim B, O'Sullivan O, O'Reilly B. How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse? Int Urogynecol J. 2018;29(8):1075–9.

    Article  PubMed  Google Scholar 

  11. Huang LY, Chu LC, Chiang HJ, Chuang FC, Kung FT, Huang KH. Medium-term comparison of uterus preservation versus hysterectomy in pelvic organ prolapse treatment with Prolift mesh. Int Urogynecol J. 2015;26(7):1013–20.

    Article  PubMed  Google Scholar 

  12. Komisaruk BR, Frangos E, Whipple B. Hysterectomy improves sexual response? Addressing a crucial omission in the literature. J Minim Invasive Gynecol. 2011;18(3):288–95.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kow N, Goldman HB, Ridgeway B. Management options for women with uterine prolapse interested in uterine preservation. Current urology reports. 2013;14(5):395–402.

    Article  PubMed  Google Scholar 

  14. Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt 1):299–305.

    Article  CAS  PubMed  Google Scholar 

  15. Mowat A, Maher C, Ballard E. Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2016;215(1):21–33.

    Article  PubMed  Google Scholar 

  16. Bedford ND, Seman EI, O'Shea RT, Keirse MJ. Effect of uterine preservation on outcome of laparoscopic uterosacral suspension. J Minim Invasive Gynecol. 2013;20(2):172–7.

    Article  PubMed  Google Scholar 

  17. Glazener CM, Breeman S, Elders A, et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet. 2017;389(10067):381–92.

    Article  PubMed  Google Scholar 

  18. Zucchi A, Lazzeri M, Porena M, Mearini L, Costantini E. Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol. 2010;7(11):626–33.

    Article  PubMed  Google Scholar 

  19. Frick AC, Barber MD, Paraiso MF, Ridgeway B, Jelovsek JE, Walters MD. Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse. Female pelvic medicine & reconstructive surgery. 2013;19(2):103–9.

    Article  Google Scholar 

  20. Wu MP, Long CY, Liang CC, Weng SF, Tong YC. Trends in reoperation for female stress urinary incontinence: a nationwide study. Neurourol Urodyn. 2015;34(7):693–8.

    Article  PubMed  Google Scholar 

  21. van IJsselmuiden NM, Detollenaere RJ, et al. Dutch women's attitudes towards hysterectomy and uterus preservation in surgical treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2018;220:79–83.

    Article  PubMed  Google Scholar 

  22. Khan AA, Eilber KS, Clemens JQ, Wu N, Pashos CL, Anger JT. Trends in management of pelvic organ prolapse among female Medicare beneficiaries. Am J Obstet Gynecol. 2015;212(4):463 e1–8.

    Article  Google Scholar 

  23. Food and Drug Administration. Urogynecologic surgical mesh: update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. July, 13, 2011. https://www.fdagov/medical-devices/implants-and-prosthetics. 2011.

  24. Food and Drug Administration. Urogynecologic surgical mesh implants. April, 16, 2019. https://www.fdagov/medical-devices/implants-and-prosthetics. 2019.

  25. Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):470 e1–6.

    Article  Google Scholar 

  26. Costantini E, Porena M, Lazzeri M, Mearini L, Bini V, Zucchi A. Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy. Int Urogynecol J. 2013;24(9):1481–7.

    Article  PubMed  Google Scholar 

  27. Altman D, Granath F, Cnattingius S, Falconer C. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet. 2007;370(9597):1494–9.

    Article  PubMed  Google Scholar 

  28. Brubaker L, Nygaard I, Richter HE, et al. Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol. 2008;112(1):49–55.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Anger JT, Rodriguez LV, Wang Q, Pashos CL, Litwin MS. The role of provider volume on outcomes after sling surgery for stress urinary incontinence. J Urol. 2007;177(4):1457–62.

    Article  PubMed  Google Scholar 

  30. Healy MA, Mullard AJ, Campbell DA Jr, Dimick JB. Hospital and payer costs associated with surgical complications. JAMA Surg. 2016;151(9):823–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, No. 901, Chunag-Hwa Rd., Yu Kang, Tainan, Taiwan

    Yi-Lun Lin & Ming-Ping Wu

  2. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung General Hospital, Keelung, Taiwan

    Tsia-Shu Lo

  3. School of Medicine, Chang Gung University, Taoyuan, Taiwan

    Tsia-Shu Lo

  4. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Cheng-Yu Long

  5. Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Cheng-Yu Long

  6. Department of Obstetrics and Gynecology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan

    Kim-Seng Law

  7. Department of Medical Research, Chi Mei Foundation Hospital, Tainan, Taiwan

    Chung-Han Ho

  8. Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan

    Ming-Ping Wu

Authors
  1. Yi-Lun Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsia-Shu Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng-Yu Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kim-Seng Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chung-Han Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ming-Ping Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ming-Ping Wu.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Fig. 5
figure 5

Transvaginal mesh commercial kits yearly used at Taiwan by year during 2006–2013

Full size image

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, YL., Lo, TS., Long, CY. et al. Time-frame comparison of hystero-preservation in the surgical treatment of uterine prolapse: a population-based nation-wide follow-up descriptive study, 2006–2013 versus 1997–2005. Int Urogynecol J 31, 1839–1850 (2020). https://doi.org/10.1007/s00192-019-04128-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04128-z

Keywords

Search

Navigation