Surgical management of pelvic organ prolapse and uterine descent in the Netherlands

Abstract

In the Netherlands, surgical policy in the case of uterine descent is very variable, with no clear preference for either hysterectomy or uterus preservation. There was a high increase in hospital admissions and pelvic organ prolapse procedures in the last decade. The number of vaginal hysterectomies performed because of uterine descent did not follow this change, which reflects a trend toward preserving the uterus.

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

“…Uterus preservation has gained popularity among gynaecologists and patients during the past years. 6 7 8 9 A recent trial among 213 women from multiple study sites throughout the United States found that 36% of the women preferred uterus preservation, 20% preferred hysterectomy, and 44% had no preference, assuming equal outcomes after both procedures. 7 Another preference study among 100 women showed that 60% would decline hysterectomy if an equally efficacious alternative was available.…”

“…The lifetime risk for prolapse surgery is 11-20%, and worldwide vaginal hysterectomy is the most commonly performed surgical procedure for uterine prolapse. 2 3 4 5 6 Performing a hysterectomy for uterine prolapse is not an evidence based practice and whether or not the uterus should be removed is debatable. Uterus preserving procedures such as vaginal sacrospinous hysteropexy, in which the uterus is attached to the sacrospinous ligament, are becoming more popular.…”

“…In a recent study we found a trend towards more uterus preservation in the Netherlands, which is in line with more women opting to retain their uterus in case of an equal outcome with hysterectomy. 6 7 8 9 Uterus preservation is thought to be less invasive, and in prospective non-randomised and retrospective cohort studies sacrospinous hysteropexy was as effective as vaginal hysterectomy, with a similar rate of recurrence and repeat surgery but with a shorter operating time, less blood loss, faster recovery, and fewer complications. 10 11 12 A hysterectomy has known benefits as well: it prevents the development of uterine cancer and stops menstrual bleeding in premenopausal women.…”

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

“…Surgical management of uterine prolapse varies greatly and currently no evidencebased guidelines exist to guide the surgeon when choosing between the different apical suspension procedures. 66 Vaginal hysterectomy has traditionally been the most common approach in the treatment of uterine prolapse 7 but uterus-preserving procedures are now gaining popularity 68,69 . Minimally invasive sacrohysteropexies provide a cure rate of up to 95%.…”

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy—a multicentre randomised controlled trial (LAVA trial)

“…4,5 However, uterus preservation techniques are gaining interest and more of these operations have been done in recent years. [6][7][8][9] In concert with this, more women express a preference for uterine preservation. [10][11][12] Women may want to avoid hysterectomy because they feel the uterus is important for a sense of self-esteem and plays a role in sexual satisfaction, the added surgical risk of hysterectomy, and/or a desire to preserve fertility.…”