Uterine preservation during surgery for uterovaginal prolapse: a review

Abstract

The traditional surgical treatment for uterovaginal prolapse has been vaginal hysterectomy. For many reasons, women may request uterine preservation at the time of prolapse surgery. The purpose of this paper is to review the medical literature pertaining to the role of uterine preservation during reconstructive surgery for uterovaginal prolapse. A MEDLINE search of literature in the English language (1966 to current) was carried out using the keywords 'hysterectomy', 'hysteropexy', 'uterine preservation', 'uterine suspension' and 'uterovaginal prolapse.' Fourteen articles primarily addressing the surgical repair of uterovaginal prolapse with uterine preservation were included in this review. Papers primarily addressing other forms of pelvic organ prolapse, incontinence or obliterative procedures were excluded. Existing procedures and their clinical outcomes were reviewed. The current literature suggests that uterine preservation during surgery for uterovaginal prolapse may be an option in appropriately selected women who desire it; prospective, randomized trials are needed to corroborate this.

Treatment of pelvic organ prolapse

“…An active search for potential and undeveloped defects must be made at the time of prolapse surgery to reduce the chance of failure. 20 Site-specific repair of pelvic support defects is currently advocated. 21 This helps to maximally restore the normal biochemical support and suspension of the central pelvic organs.…”

“…It was described by Archibald Donald of Manchester in 1888 as a feasible alternative option to vaginal hysterectomy for treatment of uterovaginal prolapse. 20 The procedure involves amputation of the cervix, shortening and approximation of the cardinal ligament, and anterior colporrhaphy with or without posterior colporrhaphy. Manchester repair has not proved to be so popular in recent times because of the challenge to fertility that results from amputation of the cervix.…”

“…It is associated with shorter operating time, less blood loss, and lower morbidity and mortality than vaginal hysterectomy. 20 ii) Sacrohysteropexy/sacrocervicopexy is performed by inserting a mesh anteriorly to the posterior lower uterus or junction of the cervix and uterus, connecting it to anterior longitudinal ligaments over the first sacral vertebra. This is useful in correcting uterine prolapse.…”

“…iii) Transvaginal uterosacral suspension/application was described in a small group of young women who had uterovaginal prolapse in 1966. 20 The procedure involved performing posterior colpotomy to assess the pouch of Douglas. The uterosacral ligaments were cut, plicated and re-inserted into the cervix.…”

“…The challenge of reduced fertility and the dyspareunia associated with some other uterus conserving surgical procedures are not experienced with this method. 20 v) Abdominal sacral colpopexy involves the suspension of the vaginal vault to the sacral promontory. It can also be used to correct high cystocoele and rectocoele with a single mesh in an inverted Y shaped fashion.…”