Uterine-preserving POP surgery

Gutman, Robert and Maher, Christopher (2013) Uterine-preserving POP surgery. International Urogynecology Journal, 24 11: 1803-1813. doi:10.1007/s00192-013-2171-2


Author Gutman, Robert
Maher, Christopher
Title Uterine-preserving POP surgery
Journal name International Urogynecology Journal   Check publisher's open access policy
ISSN 0937-3462
1433-3023
Publication date 2013-11
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s00192-013-2171-2
Open Access Status
Volume 24
Issue 11
Start page 1803
End page 1813
Total pages 11
Place of publication London, United Kingdom
Publisher Springer
Collection year 2014
Language eng
Formatted abstract
Introduction and hypothesis
To review the safety and efficacy of uterine preservation surgery.

Methods
Every four years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs. Grade C recommendation usually depends on level 4 studies or “majority evidence” from level 2/3 studies or Delphi processed expert opinion. Grade D “no recommendation possible” would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi.

Results
A wide variety of surgical options remain for women presenting with uterine prolapse without contraindications to uterine preservation. However, long-term data are limited and the need for subsequent hysterectomy unknown (grade C). Sacrospinous hysteropexy is as effective as vaginal hysterectomy and repair in retrospective comparative studies and in a meta-analysis with reduced operating time, blood loss and recovery time. However, in a single RCT there was a higher recurrence rate associated with sacrospinous hysteropexy compared with vaginal hysterectomy (grade D). Severe prolapse increases the risk of recurrent prolapse after sacrospinous hysteropexy. In consistent level 2 evidence sacrospinous hysteropexy with mesh augmentation of the anterior compartment was as effective as hysterectomy and mesh augmentation with no significant difference in the rate of mesh exposure between the groups (grade B). Level 1 evidence from a single RCT suggests that vaginal hysterectomy and uterosacral suspension were superior to sacral hysteropexy based on reoperation rates, despite similar anatomical and symptomatic improvement (grade C). Consistent level 2 and 3 evidence suggests that sacral hysteropexy (open or laparoscopic) was as effective as sacral colpopexy and hysterectomy in anatomical outcomes; however, the sacral colpopexy and hysterectomy were associated with a five times higher rate of mesh exposure compared with sacral hysteropexy (grade B). Performing hysterectomy at sacral colpopexy was associated with a four times higher risk of mesh exposure compared with sacral colpopexy without hysterectomy (grade B).

Conclusion
While uterine preservation is a viable option for the surgical management of uterine prolapse the evidence on safety and efficacy is currently lacking.
Keyword Uterine prolapse
Sacral hysteropexy
Sacrospinous hysteropexy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 24 times in Scopus Article | Citations
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Created: Sun, 10 Nov 2013, 00:51:05 EST by System User on behalf of Obstetrics & Gynaecology - RBWH