Several authors have recently compared the outcomes and complications of surgical procedures that preserve or remove the uterus in the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Following the publication of several high quality randomized control trials on this topic we performed a new systematic review and meta analysis of this data.
We performed a systematic literature search in ClinicalTrials.gov, PubMed, Scopus, Ovid, EBSCO host, Science Direct, Web of Science, and Cochrane CENTRAL for randomized controlled and cohort trials of uterine sparing prolapse repair (hysteropexy) versus hysterectomy with suspension. A total of 1285 patients from 14 studies were included in our systematic review and meta-analysis.
Uterine sparing procedures (hysteropexy) were comparable to hysterectomy with suspension for recurrence rates (RR = 0.908, 95% CI [0.385, 2.143]), reoperation rates (RR = 1.517, 95% CI [0.802, 2.868]), length of hospital stay, (SMD = - 0.159 days, 95% CI [-0.375, 0.057]), voiding dysfunction (RR = 1.089, 95% CI [0.695, 1.706]), and intraoperative blood loss (SMD = - 0.339, 95% CI [-0.631, 0.047]). However, hysteropexy had shorter operative time than hysterectomy with suspension (SMD = - 1.191 h, 95% CI [-1.836, -0.545]), and fewer visceral injuries (RR = 0.421, 95% CI [0.244, 0.725]).
We found no significant differences in the outcomes or major complications of uterine preserving surgical procedures versus those which include hysterectomy in the treatment of POP. Hysteropexy procedures may be associated with a shorter operative time and fewer visceral injuries. This is consistent with older analyses.
European journal of obstetrics, gynecology, and reproductive biology. 2021 Oct 22 [Epub ahead of print]
Ali Azadi, Greg Marchand, Ahmed Taher Masoud, Katelyn Sainz, Malini Govindan, Kelly Ware, Alexa King, Stacy Ruther, Giovanna Brazil, Nicolas Calteux, Hollie Ulibarri, Julia Parise, Amanda Arroyo, Catherine Coriell, Sydnee Goetz, Donald R Ostergard
Star Urogynecology, Advanced Pelvic Health Institute for Women, Peoria, AZ, USA; University of Arizona, College of Medicine, Department of Obstetrics and Gynecology, Phoenix, AZ, USA., Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA. Electronic address: ., Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; Faculty of Medicine, Fayoum University, Fayoum, Egypt., Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA., Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; International University of the Health Sciences, Basseterre, Sain Kitts and Nevis., University of California, Irvine, Professor Emeritus, Department of Obstetrics and Gynecology, USA; UCLA School of Medicine, Professor-in-Residence, Division of Urogynecology, USA.