Skip to main content
Top
Published in: International Urogynecology Journal 10/2020

01-10-2020 | Sacrocolpopexy | Original Article

Comparison between laparoscopic sacrocolpopexy with hysterectomy and hysteropexy in advanced urogenital prolapse

Authors: Ester Illiano, Konstantinos Giannitsas, Elisabetta Costantini

Published in: International Urogynecology Journal | Issue 10/2020

Login to get access

Abstract

Introduction and hypothesis

The aim of this study was to compare the outcomes in women who underwent laparoscopic sacrocolpopexy (LSC) with or without hysterectomy for pelvic organ prolapse (POP).

Methods

This was a single-centre prospective study. We included women with symptomatic POP (III–IV stage) who underwent LSC with or without hysterectomy. The preoperative evaluation included a history, clinical examination and urodynamic test; all patients completed FSFI, UDI-6 and IIQ-7 questionnaires. They were followed up at 1, 3, 6 and 12 months after surgery and then annually thereafter with the same preoperative flow chart. At the last visit, they also completed the PGI-I questionnaire.

Results

Between 2012 and 2016, a total of 136 patients with POP were included (82 in the LSC with hysterectomy group and 54 in the hysteropexy group). At a median follow-up of 65.3 months (36–84 months), there were improvements in the anatomical and functional outcomes of both groups without differences between the two approaches. The apical success rate was 100% in all women, without recurrence in either group; the anterior and posterior success rates of hysterectomy were higher than those of uterine preservation.

Conclusion

This study showed that there were no differences in the anatomical and functional outcomes between LSC with or without hysterectomy for POP.
Literature
1.
go back to reference Costantini E, Mearini L, Bini V, Zucchi A, Mearini E, Porena M. Uterus preservation in surgical correction of urogenital prolapse. Eur Urol. 2005;48(4):642–9.CrossRef Costantini E, Mearini L, Bini V, Zucchi A, Mearini E, Porena M. Uterus preservation in surgical correction of urogenital prolapse. Eur Urol. 2005;48(4):642–9.CrossRef
2.
go back to reference Jeon MJ, Jung HJ, Choi HJ, Kim SK, Bai SW. Is hysterectomy or the use of graft necessary for the reconstructive surgery for uterine prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):351–5.CrossRef Jeon MJ, Jung HJ, Choi HJ, Kim SK, Bai SW. Is hysterectomy or the use of graft necessary for the reconstructive surgery for uterine prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):351–5.CrossRef
3.
go back to reference Bai SW, Kim EH, Shin JS, Kim SK, Park KH, Lee DH. A comparison of different pelvic reconstruction surgeries using mesh for pelvic organ prolapse patients. Yonsei Med J. 2005;46(1):112–8.CrossRef Bai SW, Kim EH, Shin JS, Kim SK, Park KH, Lee DH. A comparison of different pelvic reconstruction surgeries using mesh for pelvic organ prolapse patients. Yonsei Med J. 2005;46(1):112–8.CrossRef
4.
go back to reference Pan K, Cao L, Ryan NA, Wang Y, Xu H. Laparoscopic sacral hysteropexy vs laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J. 2016;27:93–101.CrossRef Pan K, Cao L, Ryan NA, Wang Y, Xu H. Laparoscopic sacral hysteropexy vs laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J. 2016;27:93–101.CrossRef
5.
go back to reference Gracia M, Perello M, Bataller E, et al. Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: a pilot study. Neurourol Urodyn. 2015;34:654–8.CrossRef Gracia M, Perello M, Bataller E, et al. Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: a pilot study. Neurourol Urodyn. 2015;34:654–8.CrossRef
6.
go back to reference Maher CF, Cay MP, Slack MC, Murray CJ, Milligan M, Schluter P. Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J. 2001;12:384–5. Maher CF, Cay MP, Slack MC, Murray CJ, Milligan M, Schluter P. Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J. 2001;12:384–5.
7.
go back to reference Hefni M, El-Toukhy T, Bhaumik J, Katsimanis E. Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol. 2003;188:645–50.CrossRef Hefni M, El-Toukhy T, Bhaumik J, Katsimanis E. Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol. 2003;188:645–50.CrossRef
8.
go back to reference Van Brummen HJ, van de Pol G, Aalders CI, Heintz AP, van der Vaart CH. Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:350–5.CrossRef Van Brummen HJ, van de Pol G, Aalders CI, Heintz AP, van der Vaart CH. Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:350–5.CrossRef
9.
go back to reference Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(2):209–16.CrossRef Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(2):209–16.CrossRef
10.
go back to reference Hefni MA, El-Toukhy TA. Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):257–63.CrossRef Hefni MA, El-Toukhy TA. Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):257–63.CrossRef
11.
go back to reference Kovac SR, Cruikshank SH. Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol. 1993;168(6 Pt 1):1778–83; discussion 83–8.CrossRef Kovac SR, Cruikshank SH. Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol. 1993;168(6 Pt 1):1778–83; discussion 83–8.CrossRef
12.
go back to reference Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG. 2004;111(1):50–6.CrossRef Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG. 2004;111(1):50–6.CrossRef
13.
go back to reference Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.CrossRef Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.CrossRef
14.
go back to reference Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14(2):131–9.CrossRef Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14(2):131–9.CrossRef
15.
go back to reference Artibani W, Pesce F, Prezioso D, Scarpa RM, Zattoni F, Tubaro A, et al. Italian validation of the urogenital distress inventory and its application in LUTS patients. Eur Urol. 2006;50:1323–9.CrossRef Artibani W, Pesce F, Prezioso D, Scarpa RM, Zattoni F, Tubaro A, et al. Italian validation of the urogenital distress inventory and its application in LUTS patients. Eur Urol. 2006;50:1323–9.CrossRef
16.
go back to reference Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.CrossRef Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.CrossRef
17.
go back to reference Illiano E, Ditonno P, Giannitsas K, et al. Robot-assisted vs laparoscopic sacrocolpopexy for high-stage pelvic organ prolapse: a prospective, randomized, single-center study. Urology. 2019;134:116–23.CrossRef Illiano E, Ditonno P, Giannitsas K, et al. Robot-assisted vs laparoscopic sacrocolpopexy for high-stage pelvic organ prolapse: a prospective, randomized, single-center study. Urology. 2019;134:116–23.CrossRef
18.
go back to reference Balsamo R, Illiano E, Zucchi A. Sacrocolpopexy with polyvinylidene fluoride mesh for pelvic organ prolapse: mid term comparative outcomes with polypropylene mesh. Eur J Obstet Gynecol Reprod Biol. 2018;220:74–8.CrossRef Balsamo R, Illiano E, Zucchi A. Sacrocolpopexy with polyvinylidene fluoride mesh for pelvic organ prolapse: mid term comparative outcomes with polypropylene mesh. Eur J Obstet Gynecol Reprod Biol. 2018;220:74–8.CrossRef
19.
go back to reference Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:523–8.CrossRef Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:523–8.CrossRef
20.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRef
21.
go back to reference Costantini E, Mearini L, Lazzeri M, Bini V, Nunzi E, di Biase M, et al. Laparoscopic versus abdominal sacrocolpopexy: a randomized. controlled trial. J Urol. 2016;196(1):159–65.CrossRef Costantini E, Mearini L, Lazzeri M, Bini V, Nunzi E, di Biase M, et al. Laparoscopic versus abdominal sacrocolpopexy: a randomized. controlled trial. J Urol. 2016;196(1):159–65.CrossRef
22.
go back to reference Siddiqui NY, Fulton RG, Kuchibhatla M, Wu JM. Sexual function after vaginal versus nonvaginal prolapse surgery. Female Pelvic Med Reconstr Surg. 2012;18(4):239–42.CrossRef Siddiqui NY, Fulton RG, Kuchibhatla M, Wu JM. Sexual function after vaginal versus nonvaginal prolapse surgery. Female Pelvic Med Reconstr Surg. 2012;18(4):239–42.CrossRef
23.
go back to reference De La Cruz JF, Myers EM, Geller EJ. Vaginal versus robotic hysterectomy and concomitant pelvic support surgery: a comparison of postoperative vaginal length and sexual function. J Minim Invasive Gynecol. 2014;21(6):1010–4.CrossRef De La Cruz JF, Myers EM, Geller EJ. Vaginal versus robotic hysterectomy and concomitant pelvic support surgery: a comparison of postoperative vaginal length and sexual function. J Minim Invasive Gynecol. 2014;21(6):1010–4.CrossRef
24.
go back to reference Illiano E, Giannitsas K, Li Marzi V, et al. No treatment required for asymptomatic vaginal mesh exposure. Urol Int. 2019;103(2):223–7.CrossRef Illiano E, Giannitsas K, Li Marzi V, et al. No treatment required for asymptomatic vaginal mesh exposure. Urol Int. 2019;103(2):223–7.CrossRef
25.
go back to reference Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol. 2006;194(5):1418–22.CrossRef Wu JM, Wells EC, Hundley AF, et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol. 2006;194(5):1418–22.CrossRef
26.
go back to reference Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol. 2008;15(2):188–96.CrossRef Stepanian AA, Miklos JR, Moore RD, Mattox TF. Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic assisted vaginal hysterectomy: experience of 402 patients. J Minim Invasive Gynecol. 2008;15(2):188–96.CrossRef
27.
go back to reference Cundiff GW, Varner E, Visco AG, et al. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol. 2008;199(6):688.e1–5.CrossRef Cundiff GW, Varner E, Visco AG, et al. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol. 2008;199(6):688.e1–5.CrossRef
28.
go back to reference De Oliveira SA, Fonseca MCM, Bortolini MAT, et al. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis. Int Urogynecol J. 2017;28(11):1617–30.CrossRef De Oliveira SA, Fonseca MCM, Bortolini MAT, et al. Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis. Int Urogynecol J. 2017;28(11):1617–30.CrossRef
Metadata
Title
Comparison between laparoscopic sacrocolpopexy with hysterectomy and hysteropexy in advanced urogenital prolapse
Authors
Ester Illiano
Konstantinos Giannitsas
Elisabetta Costantini
Publication date
01-10-2020
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 10/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-020-04260-1

Other articles of this Issue 10/2020

International Urogynecology Journal 10/2020 Go to the issue