Hysteropexy for POP: which technique is best?

  • Meriwether KV & al.
  • Int Urogynecol J
  • 11 Feb 2019

  • curated by Craig Hicks
  • Clinical Essentials
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Takeaway

  • For different types of hysteropexies, few studies have compared outcomes, even though approaches have a wide range of risk for pelvic organ prolapse (POP) recurrence and adverse events (AEs).

Why this matters

  • Surgeons with patients who desire uterine preservation during POP surgery should be cautious about offering 1 type of hysteropexy over another, say researchers. But they should counsel patients that minimally invasive approaches can limit morbidity or operating time.

Study design

  • Researchers analyzed 99 comparative or single-group studies involving the following surgery types:
    • open mesh sacrohysteropexy (SHP),
    • laparoscopic or robotic-assisted mesh SHP,
    • other open abdominal hysteropexy procedures (non-SHP),
    • other laparoscopic or robotic-assisted hysteropexy procedures (non-SHP).
    • transvaginal mesh hysteropexy,
    • transvaginal native-tissue hysteropexies such as sacrospinous hysteropexy or uterosacral, hysteropexy,
    • Manchester procedure, and
    • LeFort colpocleisis.
  • Funding: Society of Gynecologic Surgeons.

Key results

  • Repeat POP surgery after hysteropexy varied widely by hysteropexy type (0%-29%).
  • Laparoscopic vs open hysteropexies had:
    • Lower POP recurrence: OR, 0.18 (95% CI, 0.07-0.46); 
    • Urinary retention: OR, 0.05 (95% CI, 0.003-0.83); and
    • Blood loss: mean difference, −104 mL (95% CI, −145 to −63 mL).
  • Common AEs included mesh exposure (0%-39%), urinary retention (0%-80%), and sexual dysfunction (0%-48%).

Limitations

  • Studies were heterogeneous and most were of poor quality.

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