Skip to main content
Log in

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

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



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.


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.


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.


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

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others



Body mass index


British Society of Urogynaecology


Confidence interval


Manchester procedure


Odds ratio


Pelvic floor repair


Patient Global Impression of Improvement


Pelvic Organ Prolapse Quantification


Standard deviation


Sacrospinous ligament hysteropexy


  1. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline. Published 2 April 2019

  2. Marquini GV, De Jarmy Di Bella ZIK, Sartori MGF. The Manchester-Fothergill technique: browsing in the cutting-edge art gallery. Int J Gynecol Obstet. 2022;156(1):10–6.

    Article  Google Scholar 

  3. Developed by the Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Int Urogynecol J. 2020;31(3):429–63.

  4. Tolstrup CK, Lose G, Klarskov N. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse: a review. Int Urogynecol J. 2017;28(1):33–40.

    Article  PubMed  Google Scholar 

  5. Schulten SFM, Essers B, Notten KJB, et al. Patient’s preference for sacrospinous hysteropexy or modified Manchester operation: a discrete choice experiment. BJOG. 2023;130(1):99–106.

    Article  PubMed  Google Scholar 

  6. Kapoor S, Sivanesan K, Robertson JA, Veerasingham M, Kapoor V. Sacrospinous hysteropexy: review and meta-analysis of outcomes. Int Urogynecol J. 2017;28(9):1285–94.

    Article  PubMed  Google Scholar 

  7. History of BSUG. Available from: Accessed 10 Jan 2023.

  8. Detollenaere RJ, Den Boon J, Stekelenburg J, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;23:h3717.

    Article  Google Scholar 

  9. Fleiss JL. Statistical methods for rates and proportions. 3rd ed. New York: Wiley; 2003.

    Book  Google Scholar 

  10. Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4:28–37.

    Google Scholar 

  11. Nahm FS. Nonparametric statistical tests for the continuous data: the basic concept and the practical use. Korean J Anesthesiol. 2016;69(1):8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kim HY. Statistical notes for clinical researchers: Chi-squared test and Fisher’s exact test. Restor Dent Endod. 2017;42(2):152.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Routledge; 1988.

    Google Scholar 

  14. Dharmasena D, Spence-Jones C, Khasriya R, Yoong W. Manchester repair (‘Fothergill’s operation’) revisited. Obstet Gynaecol. 2021;23(2):148–53.

    Article  Google Scholar 

  15. Schulten SFM, Claas-Quax MJ, Weemhoff M, et al. Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis. Am J Obstet Gynecol. 2022;227(2):192–208.

    Article  PubMed  Google Scholar 

  16. Enklaar RA, Schulten SFM, Van Eijndhoven HWF, et al. Manchester procedure vs sacrospinous hysteropexy for treatment of uterine descent: a randomized clinical trial. JAMA. 2023;330(7):626.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shemer O, Vinikov Y, Shaubi-Rosen M, Levy G. Cervical elongation—the search for a definition. Maedica (Bucur). 2022;17(2):487–91.

    PubMed  Google Scholar 

Download references


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.

Author information

Authors and Affiliations



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.

Ethics declarations

Ethics Approval

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

Conflicts of Interest


Additional information

Handling Editor: Jaromir Masata

Editor in Chief: Maria A. Bortolini

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: