Faculty Opinions recommendation of Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial.

Abstract Introduction and hypothesis The modified Manchester (MM) and sacrospinous hysteropexy (SSH) are the most common uterus-preserving surgical procedures for uterine descent. Little is known about gynecologists’ preferences regarding the two interventions. The study’s aim was to identify which factors influence Dutch (uro)gynecologists when choosing one of these techniques. Methods This qualitative study consists of ten semi-structured interviews with Dutch (uro)gynecologists using predetermined, open explorative questions, based on a structured topic list. An inductive content analysis was performed using Atlas.ti. Results For SSH, the majority (6/10 gynecologists) reported the more dorsal change of direction of the vaginal axis as a disadvantage and expected more cystocele recurrences (7/10). The most reported disadvantage of MM was the risk of cervical stenosis (7/10). Four gynecologists found MM not to be appropriate for patients with higher stage uterine prolapse. The quality of the uterosacral ligaments was related to the chance of recurrence according to five gynecologists. Patient counseling was biased toward one of the uterus-preserving operations (7/10). Four gynecologists stated they make the final decision while two let patient-preference lead the final decision. Conclusions Preference for one of the uterus-preserving interventions is mainly based on the gynecologist’s own experience and background. The lack of information regarding these two uterus-preserving procedures hampers evidence-based decision making, which explains the practice pattern variation. In conclusion, further research is needed to improve evidence-based counseling and shared decision making regarding the choice of procedure.

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Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial

BMJ ◽

10.1136/bmj.l5149 ◽

2019 ◽

pp. l5149 ◽

Cited By ~ 11

Author(s):

Sascha F M Schulten ◽

Renée J Detollenaere ◽

Jelle Stekelenburg ◽

Joanna IntHout ◽

Kirsten B Kluivers ◽

...

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Uterosacral Ligament ◽

Uterosacral Ligament Suspension ◽

Recurrent Prolapse ◽

Composite Outcome ◽

Repeat Surgery ◽

Sacrospinous Hysteropexy ◽

Apical Compartment

Abstract Objective To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery. Design Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial. Setting Four non-university teaching hospitals, the Netherlands. Participants 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years. Main outcome measures Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning. Results At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference−6.7%, 95% confidence interval −12.8% to−0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions. Conclusions At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures. Trial registration trialregister.nl NTR1866.

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Cure of Interstitial Cystitis and Non-Ulcerating Hunner’s Ulcer by Cardinal/Uterosacral Ligament Repair

Urologia Internationalis ◽

10.1159/000515647 ◽

2021 ◽

pp. 1-4

Author(s):

Kay Scheffler ◽

Oliver W. Hakenberg ◽

Peter Petros

Keyword(s):

Interstitial Cystitis ◽

Uterine Prolapse ◽

English Literature ◽

German Literature ◽

Uterosacral Ligament ◽

Original Intention ◽

Uterosacral Ligaments ◽

Bladder Symptoms ◽

Posterior Fornix ◽

The Relationship

A serendipitous cure in a 73-year-old woman of Hunner’s ulcer, urge, nocturia, apical prolapse by a tissue fixation system tensioned minisling (TFS) which reinforced the cardinal, and uterosacral ligaments (USLs) led us to analyse the relationship between Hunner’s ulcer and known pain conditions associated with USL laxity. The original intention was to cure the “posterior fornix syndrome” (PFS), uterine prolapse, and associated pain and bladder symptoms by USL repair. A speculum inserted preoperatively into the posterior fornix alleviated pain and urge symptoms, by mechanically supporting USLs. Hunner’s ulcer, along with pain and other PFS symptoms were cured by USL repair. The concept of USL laxity causing chronic pelvic pain and bladder problems is not new. It was published in the German literature by Heinrich Martius in 1938 and by Petros in the English literature in 1993. These findings raise important questions. As PFS symptoms are identical with those of interstitial cystitis (IC), are PFS and IC similar conditions? If so, then patients with IC who have a positive speculum test are at least theoretically, potentially curable by USL repair. These questions need to be explored.

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The effectiveness of McCall culdoplasty following vaginal hysterectomy in advanced stages of uterine prolapse

International Urogynecology Journal ◽

10.1007/s00192-021-04890-z ◽

2021 ◽

Author(s):

Elad Barber ◽

Ilia Kleiner ◽

Daniel Tairy ◽

Jacob Bar ◽

Shimon Ginath

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Mccall Culdoplasty ◽

Advanced Stages

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Laparoscopic sacrohysteropexy versus vaginal hysterectomy and apical suspension: 7-year follow-up of a randomized controlled trial

International Urogynecology Journal ◽

10.1007/s00192-021-04932-6 ◽

2021 ◽

Author(s):

Matthew L. Izett-Kay ◽

Philip Rahmanou ◽

Rufus J. Cartwright ◽

Natalia Price ◽

Simon R. Jackson

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Controlled Trial ◽

Apical Prolapse ◽

Apical Suspension ◽

Vaginal Length ◽

Patient Reported ◽

Laparoscopic Sacrohysteropexy ◽

Total Vaginal Length

Abstract Introduction and hypothesis Laparoscopic mesh sacrohysteropexy offers a uterine-sparing alternative to vaginal hysterectomy with apical suspension, although randomised comparative data are lacking. This study was aimed at comparing the long-term efficacy of laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse. Methods A randomised controlled trial comparing laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse was performed, with a minimum follow-up of 7 years. The primary outcome was reoperation for apical prolapse. Secondary outcomes included patient-reported mesh complications, Pelvic Organ Prolapse Quantification, Patient Global Impression of Improvement in prolapse symptoms and the International Consultation on Incontinence Questionnaire Vaginal Symptoms, Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and PISQ-12 questionnaires. Results A total of 101 women were randomised and 62 women attended for follow-up at a mean of 100 months postoperatively (range 84–119 months). None reported a mesh-associated complication. The risk of reoperation for apical prolapse was 17.2% following vaginal hysterectomy (VH) and 6.1% following laparoscopic mesh sacrohysteropexy (LSH; relative risk 0.34, 95% CI 0.07–1.68, p = 0.17). Laparoscopic sacrohysteropexy was associated with a statistically significantly higher apical suspension (POP-Q point C −5 vs −4.25, p = 0.02) and longer total vaginal length (9 cm vs 6 cm, p < 0.001). There was no difference in the change in ICIQ-VS scores between the two groups (ICIQ-VS change −22 vs −25, p = 0.59). Conclusion Laparoscopic sacrohysteropexy and vaginal hysterectomy with apical suspension have comparable reoperation rates and subjective outcomes. Potential advantages of laparoscopic sacrohysteropexy include a lower risk of apical reoperation, greater apical support and increased total vaginal length.

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