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01-04-2019 | Urinary Incontinence | Review Article

Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines

Authors: Kate V. Meriwether, Ethan M. Balk, Danielle D. Antosh, Cedric K. Olivera, Shunaha Kim-Fine, Miles Murphy, Cara L. Grimes, Ambereen Sleemi, Ruchira Singh, Alexis A. Dieter, Catrina C. Crisp, David D. Rahn

Published in: International Urogynecology Journal | Issue 4/2019

Abstract

Introduction and hypothesis

We aimed to systematically review the literature on pelvic organ prolapse (POP) surgery with uterine preservation (hysteropexy). We hypothesized that different hysteropexy surgeries would have similar POP outcomes but varying adverse event (AE) rates.

Methods

MEDLINE, Cochrane, and clinicaltrials.gov databases were reviewed from inception to January 2018 for comparative (any size) and single-arm studies (n ≥ 50) involving hysteropexy. Studies were extracted for participant characteristics, interventions, comparators, outcomes, and AEs and assessed for methodological quality.

Results

We identified 99 eligible studies: 53 comparing hysteropexy to POP surgery with hysterectomy, 42 single-arm studies on hysteropexy, and four studies comparing stage ≥2 hysteropexy types. Data on POP outcomes were heterogeneous and usually from <3 years of follow-up. Repeat surgery prevalence for POP after hysteropexy varied widely (0–29%) but was similar among hysteropexy types. When comparing sacrohysteropexy routes, the laparoscopic approach had lower recurrent prolapse symptoms [odds ratio (OR) 0.18, 95% confidence interval (CI) 0.07–0.46), urinary retention (OR 0.05, 95% CI 0.003–0.83), and blood loss (difference −104 ml, 95% CI −145 to −63 ml) than open sacrohysteropexy. Laparoscopic sacrohysteropexy had longer operative times than vaginal mesh hysteropexy (difference 119 min, 95% CI 102–136 min). Most commonly reported AEs included mesh exposure (0–39%), urinary retention (0–80%), and sexual dysfunction (0–48%).

Conclusions

Hysteropexies have a wide range of POP recurrence and AEs; little data exist directly comparing different hysteropexy types. Therefore, for women choosing uterine preservation, surgeons should counsel them on outcomes and risks particular to the specific hysteropexy type planned.

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Title: Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines
Authors: Kate V. Meriwether
Ethan M. Balk
Danielle D. Antosh
Cedric K. Olivera
Shunaha Kim-Fine
Miles Murphy
Cara L. Grimes
Ambereen Sleemi
Ruchira Singh
Alexis A. Dieter
Catrina C. Crisp
David D. Rahn
Publication date: 01-04-2019
Publisher: Springer International Publishing
Keywords: Urinary Incontinence
Urinary Incontinence
Hysterectomy
Published in: International Urogynecology Journal / Issue 4/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-03876-2

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Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines

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