Abstract
One hundred and three women underwent sacrospinous hysteropexy (n=54) or vaginal hysterectomy with a vaginal vault suspension (n=49) for the management of descensus uteri. They were sent a postal questionnaire. Logistic regression analysis was used to obtain crude and adjusted odds ratios. Seventy-four (72%) women responded. The adjusted odds ratios for urge incontinence is 3.4 (1.0–12.3) and for overactive bladder 2.9 (0.5–16.9) greater after vaginal hysterectomy. The women recovered significantly more quickly after sacrospinous hysteropexy. There were no differences in anatomical outcome or recurrence rate. When performed to correct a descensus uteri of grade 2 or more we found that vaginal hysterectomy is associated with a three times higher risk for urge incontinence and overactive bladder symptoms. In addition, the women who underwent sacrospinous hysteropexy also reported a quicker recovery from surgery. Sacrospinous hysteropexy, therefore, appears to be promising for the correction of descensus uteri.
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SIG Zorg-informatie, Utrecht, Landelijke Medische Registratie 1995–1999, leeftijdscategorie 15 jaar en ouder. SIG Zorginformatie 2002
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506
Brown JS, Sawaya G, Thom DH, Grady D (2000) Hysterectomy and urinary incontinence: a systematic review. Lancet 356:535–539
Kuh D, Cardozo L, Hardy R (1999) Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol CommunHealth 53:453–458
van der Vaart CH, van der Bom JC, de Leeuw JRJ, Roovers JPWR, Heintz APM (2002) The contribution of hysterectomy to the occurence of urge- and stress urinary incontinence symptoms. Br J Obstet Gynaecol 109:149–154
Smith PH, Ballantyne B (1968) The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery. Br J Surg 55:929–933
Carey MP, Slack MC (1994) Transvaginal sacrospinous colpopexy for vault and marked uterovaginal prolapse. Br J Obstet Gynaecol 101:536–540
Goldberg RP, Tomezsko JE, Winkler HA, Koduri S, Culligan PJ, Sand PK (2001) Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation. Obstet Gynecol 98:199–204
Kovac SR, Cruikshank SH (1993) Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol 168:1778–1783
Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P (2001) Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J 12:381–384
Morley GW (1996) Treatment of uterine and vaginal prolapse. Clin Obstet Gynecol 39:959–969
Nichols DH (1982) Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol 142:901–904
Ozcan U, Gungor T, Ekin M, Eken S (1999) Sacrospinous fixation for the prolapsed vaginal vault. Gynecol Obstet Invest 47:65–68
Richardson DA, Scotti RJ, Ostergard DR (1989) Surgical management of uterine prolapse in young women. J Reprod Med 34:388–392
Sze EH, Karram MM (1997) Transvaginal repair of vault prolapse: a review. Obstet Gynecol 89:466–475
Baden WF, Walker TA (1972) Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 15):1048–1054
Schumaker SA, Wyman JF, Uebersax JS, Clish D, Fantl JA (1994) Health related quality of life measures for women with urinary incontinence: The Urogenital Distress Inventory and the Incontinence Impact Questionnaire. Qual Life Res 3:291–306
Vaart van der CH, de Leeuw JRJ, Roovers JPWR, Heintz APM (2003) Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 22(2): 97–104
Abrams P, Cardozo L, Fall M et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 187:116–126
Dorsey JH, Steinberg EP, Holtz PM (1995) Clinical indications for hysterectomy route: patient characteristics or physician preference? Am J Obstet Gynecol 173:1452–1460
Kuh D, Cardozo L, Hardy R (1999) Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Commun Health 53:453–458
Moller LA, Lose G, Jorgensen T (2000) The prevalence and bothersomeness of lower urinary tract symptoms in women 40–60 years of age. Acta Obstet Gynecol Scand 79:298–305
Ryhammer AM, Laurberg S, Djurhuus JC, Hermann AP (1998) No relationship between subjective assessment of urinary incontinence and pad test weight gain in a random population sample of menopausal women. J Urol 159:800–803
Wyman JF, Choi SC, Harkins SW, Wilson MS, Fantl JA (1998) The urinary diary in evaluation of incontinent women: a test-retest analysis. Obstet Gynecol 71:812–817
Abrams P, Cardozo L, Fall M et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
Overactive Bladder and Its Treatments Consensus Conference. London, United Kingdom, 4July 1999. Urology 2000; 55:1–84
Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ (2001) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int 87:760–766
Bonney V (1934) The principles that should underlie all operations for prolapse. J Obstet Gynaecol Br Emp 41:669–683
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Editorial Comment: This is the first study looking at urinary symptoms relating to whether or not the uterus was preserved at the time of prolapse surgery. The authors should be commended for using an excellent tool for identifying symptoms and for the 75% response rate to their questionnaire. However, it is very difficult to make a statement that leaving the uterus in place definitely has an impact on preventing postoperative overactive bladder symptoms, particularly in view of the increased risk of cervical cancer and potentially endometrial cancer that accompanies leaving the uterus in place. Also, more long-term follow-up is necessary to determine how many of the women in the hysterectomy group will eventually go on to hysterectomy.
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van Brummen, H.J., van de Pol, G., Aalders, C.I.M. et al. Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J 14, 350–355 (2003). https://doi.org/10.1007/s00192-003-1084-x
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DOI: https://doi.org/10.1007/s00192-003-1084-x