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The Outcomes of the Manchester Procedure Versus Sacrospinous Ligament Hysteropexy for Uterine Prolapse: A Study of the British Society of Urogynaecology Database

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Abstract

Introduction

The Manchester procedure (MP) and sacrospinous ligament hysteropexy (SSHP) have long been established as effective conservative surgeries for treating uterine prolapse. However, there have been limited studies on outcomes comparing these two techniques.

Methodology

This was a prospective cohort study of the British Society of Urogynaecology database between February 2007 and 2023 of MP and SSHP outcomes from 90 centres in the UK. The primary outcome was the Patient Global Impression of Improvement (PGI-I). The other outcomes compared were the absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by the Pelvic Organ Prolapse Quantification (POP-Q), complications, and the incidence of reported symptomatic prolapse within 1 year after the operation.

Results

There were 718 women who underwent MP and 2,384 who had SSHP. The PGI-I score was significantly better in the MP group (p value <0.001). The rates of symptomatic prolapse within 1 year (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18–0.69; p value 0.001), recurrence of prolapse beyond the hymen (OR 0.13, 95% CI 0.03–0.53; p value 0.001) and apical recurrence (OR 0.09, 95% CI 0.01–0.65; p value 0.003) during follow-up examination were lower in the MP group. The combined peri-operative and post-operative complications reported in both groups were comparatively similar.

Conclusion

The symptom improvement was better and recurrence was lower with the MP than with SSHP at short-term follow-up.

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Abbreviations

BMI:

Body mass index

BSUG:

British Society of Urogynaecology

CI:

Confidence interval

MP:

Manchester procedure

OR:

Odds ratio

PFR:

Pelvic floor repair

PGI-I:

Patient Global Impression of Improvement

POP-Q:

Pelvic Organ Prolapse Quantification

SD:

Standard deviation

SSHP:

Sacrospinous ligament hysteropexy

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Acknowledgements

The authors would like to thank all the patients and clinicians who have contributed to the BSUG database and the Research and Development Committee at BSUG for approving our study.

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Authors

Contributions

A.C.C.T. was responsible for the data management, analysis, manuscript writing and editing; P.L. was involved in the conception of the study, protocol development, manuscript writing and editing.

Corresponding author

Correspondence to Albert Chao Chiet Tan.

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Ethics Approval

This study was approved by the British Society of Urogynaecology (BSUG) research and development committee.

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None.

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Editor in Chief: Maria A. Bortolini

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Tan, A.C.C., Latthe, P. The Outcomes of the Manchester Procedure Versus Sacrospinous Ligament Hysteropexy for Uterine Prolapse: A Study of the British Society of Urogynaecology Database. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05826-z

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