Management of uterine prolapse: is hysterectomy necessary?

Abstract

Key content Management of uterine prolapse is currently heavily influenced by patient and surgeon preferences. The traditional approach to uterine prolapse is vaginal hysterectomy. However, this does not address the underlying deficiency in connective tissue pelvic floor support, and prolapse recurrence is common. Uterine preservation surgery is increasing in popularity, both with surgeons and patients; there is currently little evidence to show superior outcome to hysterectomy. Fertility preservation remains the one absolute indication for hysteropexy. Other potential advantages include stronger apical support and reduced vaginal surgery. Colpocleisis remains a valid option for a small cohort of patients. Learning objectives Options for the management of uterine prolapse. How to help patients decide on a management plan.

Successful Pregnancy Outcome After Laparoscopic Sacrohysteropexy for Pelvic Organ Prolapse

“…Laparoscopic sacrohysteropexy is a minimally invasive surgical procedure having the advantage of short operative time, minimal blood loss, short hospital stay, maintenance of good vaginal length and caliber to enhance sexual function and favorable functional outcome, beneficial for young women who want to preserve future fertility [ 3 , 7 ].…”

“…Young age at presentation and desire of future fertility has encouraged surgeons for uterine preserving prolapse surgeries [ 2 ]. Sacrohysteropexy is a method found to be useful and provide stronger apical support resulting in a lower recurrence rate [ 3 ]. Nowadays, minimal invasive laparoscopic route is preferred over conventional methods.…”

Pelvic organ prolapse management

“…The appropriateness of hysterectomy in uterovaginal prolapse has been debated 27 as the underlying pathophysiology is related to connective tissue rather than a potentially healthy uterus. 28 Vaginal hysterectomy alone does not address this issue and recurrent prolapse rates are between 10% and 40%.…”

The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives

“…While hysterectomies are still the mainstay of prolapse surgery, this is often supplemented by McCall culdoplasty, the Moschcowitz procedure or suturing of the cardinal and uterosacral ligaments to the vaginal vault (Jefferis, Jackson, & Price, ). These techniques are thought to prevent vault prolapse postoperatively and provide additional pelvic floor support.…”

“…There has been a lack of consensuses or generally accepted guidelines on the best treatment of these conditions and, until recently, no prospective randomized trials comparing operative strategies (El Naqa, Guerrero, & Abdel, 2015). (Jefferis, Jackson, & Price, 2016). These techniques are thought to prevent vault prolapse postoperatively and provide additional pelvic floor support.…”