Uterine-preservation surgeries for pelvic organ prolapse: outcomes for various approaches

Objectives: The aim of this study was to assess subjective and objective outcomes after four different types of hysteropexy surgeries.

Methods: Our cohort included all women who underwent laparoscopic uterosacral hysteropexy (lscUSLS), vaginal uterosacral hysteropexy (USLS), vaginal sacrospinous hysteropexy (SSLF) or LeFort colpocleisis from September 2016 to June 2022 at a single institution. Patients were recruited for a follow up visit to complete the Pelvic Floor Distress Inventory (PFDI) questionnaire and undergo a Pelvic Organ Prolapse Quantification (POPQ) exam. Demographic and clinical characteristics were evaluated through electronic medical record review. Survival analysis was performed to assess composite, anatomic and retreatment failures.

Results: A total of 294 women underwent a hysteropexy procedure during this time period. Age at surgery was 68.2±13.6 years (mean±SD), with an average BMI of 26.9±5.4 kg/m² (Table 1). Preoperatively, the majority of patients presented with stage II (45.7%) and stage III (52.4%) prolapse. Operative time was 95±36 minutes, with estimated blood losses (EBL) of 84.6±56.2 mL. Approximately three-quarters of patients underwent concomitant anterior colporrhaphy (73.5%) and/or posterior colporrhaphy (79.2%) and 37.8% underwent an anti-incontinence procedure. Complications included UTI within 6 weeks (9.5%), readmission within 30 days (2.7%) and reoperation within 30 days (3.4%). There were no blood transfusions or ICU admissions.

The median follow-up was 1.4 years, ranging from 1 month to 6.3 years. 89 patients agreed to return for the follow-up for the purposes of the study. Postoperatively, POPQ exams significantly improved (p < 0.001) to 21.3% with stage 0 prolapse, 51.3% with stage I, 20.9% with stage II and only 6.5% with stage III. PFDI scores improved postoperatively from 94.0±60.7 to 48.8±44.3 (p < 0.001). Each of the three components of PFDI improved as well (p < 0.001). There were no significant differences in outcomes between vaginal USLS and vaginal SSLF. The overall composite failure rate was 13.6%, with an anatomic failure rate of 6.8% and a retreatment rate of 7.5% (Figure 1).

Conclusions: Our study demonstrates significant improvements in objective and subjective outcomes after hysteropexy procedures. Uterine-preserving procedures are effective in treating pelvic organ prolapse.