Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc
Journal website https://www.jcgo.org

Review

Volume 11, Number 3, September 2022, pages 53-61

Alternatives to Hysterectomy in Patients With Uterovaginal Prolapse

Figure

Figure 1.
Figure 1. Flowchart showing screening of studies.

Tables

Table 1. Characteristics of Studies Comparing Manchester Procedure With TVH
 
StudyDesignSurgeryFollow-upOutcomes
nrPCS: non-randomized prospective controlled study; RCT: randomized controlled trial; TVH: transvaginal hysterectomy; TVL: total vaginal length; USLS: uterosacral ligament suspension.
Thys et al [12]nrPCSManchester vs. TVH with USLS6 weeks1) Operating time: 67 vs. 101 min (P = 0.01)
2) Blood loss: 250 vs. 358 mL (P = 0.01)
3) Repeat surgery: 4% vs. 9% (P = 0.15)
Tolstrup et al [13]Prospective cohort studyManchester vs. TVH with USLS24 months1) Apical recurrence: 0.3% vs. 5.1% (P = 0.004)
2) Overall recurrence: 7.8% vs. 18.3% (P = 0.002)
3) Repeat surgery: 2% vs. 8.5% (P ≤ 0.05)
Unlubilgin et al [14]RCTManchester vs. TVH with USLS5 years1) Operating time: 62 vs. 77 min (P = 0.003)
2) Postop point C: -6.3 vs. -6 cm (P = 0.132)
3) Postop TVL: 8.3 vs. 6 cm (P = 0.016)

 

Table 2. Characteristics of Studies Comparing SSHP With Surgeries Involving Hysterectomy
 
StudyDesignSurgeries comparedFollow-upOutcomes
nrPCS: non-randomized prospective controlled study; RCT: randomized controlled trial; SHP: sacrohysteropexy; SSHP: sacrospinous hysteropexy; SUI: stress urinary incontinence; TVH: transvaginal hysterectomy; TVL: total vaginal length; UI: urgency incontinence; VMSSHP: vaginal mesh sacrospinous hysteropexy; CI: confidence interval.
Detollenaere et al [16]RCTSSHP vs. TVH12 months1) Apical failure: 2% vs. 7% (CI: -11.1 to 1.2)
2) Anterior failure: 8% vs. 6% (CI: -0.5 to 26.4)
3) Repeat surgery: 1% vs. 4% (CI: -7.8 to 2)
4) Blood loss: 202 vs. 209 mL (CI: -32.8 to 20)
5) Operating time: 59 vs. 72 min (CI: -18.5 to -8.6)
Schulten et al [17]RCTSSHP vs. TVH5 years1) Apical failure: 3% vs. 7% (CI: -10.2 to 2.5)
2) Anterior failure: 40% vs. 36% (CI: -8.9 to 17.8)
3) Repeat surgery: 3% vs. 9% (CI: -10.2 to 2.5)
Dietz et al [18]RCTSSHP vs. TVH12 months1) Apical failure: 21% vs. 3%
2) Anterior failure: 50% vs. 35% (P = 0.2)
3) Repeat surgery: 11.6% vs. 6% (CI: -9 to 19)
Jeng et al [19]RCTSSHP vs. TVH6 months1) Decrease sexual interest: 13% vs. 5.1%
2) Less frequent orgasm: 20% vs. 21%
Hefni et al [20]nrPCSSSHP vs. TVH18 months1) Apical failure: 4.9% vs. 4.1% (P = NS)
2) Anterior failure: 11.4% vs. 10.4% (P = NS)
3) Repeat surgery: 5% vs. 4% (P = NS)
4) Blood loss: 46 vs. 135 mL (P < 0.01)
5) Operating time: 51 vs. 77 min (P < 0.01)
van Brummen et al [21]nrPCSSSHP vs. TVH1) UI: 38.6% vs. 50% (P = 0.23)
2) SUI: 47.7% vs. 46.7% (P =1.00)
3) Recurrence of POP: 11.4% vs. 6.7% (P = 0.45)
van Ijsselmuiden et al [22]RCTSSHP vs. Lap SHP12 months1) Surgical failure: 3.3% vs. 1.6%
2) Apical failure: 3.4% vs. 3.6% (CI: -6.6 to 7)
3) Anterior failure: 56.9% vs. 50.9% (-24.3 to 12.4)
Nager et al [23]RCTVMSSHP vs. TVH3 years1) Failure rate: 31% vs. 41% (-25 to 4)
2) POP-Q: Ba: -1.2 vs. -0.7 cm (P = 0.05)
C: -5.7 vs. -5.8 cm (P = 0.74)
TVL: 8.5 vs. 7.7 cm (P < 0.01)
3) Operating time: 111 vs. 156 min (P < 0.01)
Chu et al [24]nrPCSVMSSHP vs. TVH9 months1) Postoperative POP-Q values (P > 0.05)
2) Operating time: 97.2 vs. 129 min (P < 0.01)
3) Blood loss: 77.4 vs. 179 mL (P < 0.01)
4) Mesh extrusion: 3.8% vs. 12.8% (P = 0.134)

 

Table 3. Study Comparing SHP Through Various Routes With TVH
 
StudyStudy designSurgeries comparedFollow-upOutcomes
RCT: randomized controlled trial; SHP: sacrohysteropexy; SSHP: sacrospinous hysteropexy; TVH: transvaginal hysterectomy; VMSSHP: vaginal mesh sacrospinous hysteropexy.
Hemming et al [25]RCT1) SSHP vs. TVH
2) VMSSHP vs. TVH
3) Abd SHP vs. TVH
4) Lap SHP vs. TVH		12 monthsUterine preservation vs. hysterectomy:
1) Overall stage II or more: 18 vs. 15 (P > 0.05)
2) Further surgery needed: 7.4% vs. 4.5% (P = 0.182)

 

Table 4. Studies Comparing Abdominal Uterus-Preserving Surgeries With Surgeries Involving Hysterectomy
 
StudyDesignSurgeries comparedFollow-upOutcomes
CSP: colposacropexy; FSFI: female sexual function index; nrPCS: non-randomized prospective controlled study; RCT: randomized controlled trial; LRSHP: laparoscopic/robotic sacrohysteropexy; SHP: sacrohysteropexy; TLH: total laparoscopic hysterectomy; TVH: transvaginal hysterectomy; TVL: total vaginal length; USLS: uterosacral ligament suspension.
Roovers et al [33]RCTAbd SHP vs. TVH12 months1) Apical failure: 5% vs. 5%
2) Anterior failure: 36% vs. 39%
3) Repeat surgery: 22% vs. 2%
3) Operating time: 97 vs. 107 min (CI: -2 to 22)
4) Blood loss: 244 vs. 248 mL (CI: -119 to 127)
Rahmanou et al [34]RCTLap SHP vs. TVH12 months1) Operating time: 39.5 vs. 28.1 min (P < 0.001)
2) Blood loss: 19.6 vs. 82.1 mL (P < 0.001)
3) Repeat surgery: 2% vs. 8% (P = 0.185)
Rosen et al [35]nrPCSLap USLS with uterus vs. TLH with USLS24 months1) Operating time: 115 vs. 150 min (P ≤ 0.001)
2) Blood loss: 100 vs. 110 mL (P = 0.0295)
3) Failure rate: 20% vs. 20%
Paek et al [36]nrPCSRLSHP vs. Abd SHP12 months1) Operating time: 120 vs. 187 min (P < 0.001)
2) Blood loss: 50 vs. 150 mL (P < 0.001)
3) Repeat surgery: 4.7% vs. 1.8% (P = 0.611)
4 ) Success rate: 94.4% vs. 91.2% (P = 0.717)
5) Mesh erosion: 0 vs. 5.3% (P = 0.244)
Constantini et al [37]nrPCSAbd hysterectomy and CSP vs. Abd SHP12 months1) FSFI score: 22.4 vs. 24.3 (P ≤ 0.05)
2) TVL: 6.5 vs. 8 cm (P = 0.828)
Constantini et al [38]nrPCSAbd hysterectomy and CSP vs. Abd SHP51 months1) Operating time: 115 vs. 89 min (P ≤ 0.05)
2) Blood loss: 325 vs. 200 mL (P ≤ 0.001)
3) Mesh erosion: 3 vs. 0
4) TVL: 6.5 vs. 8 cm (P = 0.813)
5) Success rate: 92% vs. 91% (P ≥ 0.05)