Quick Take: Sacrospinus hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher

1. Sacrospinous hysteropexy for uterine prolapse may be associated with a decreased incidence of anatomical recurrences of the apical compartment and/or bulge symptoms when compared to vaginal hysterectomy.

Evidence Rating Level: 2 (Good)

Worldwide, vaginal hysterectomy is the most common surgical procedure performed in the management of uterine prolapse. Few studies have compared vaginal hysterectomy with uterus-preserving procedures, however. The SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ³2) randomized trial compared uterus preservation with hysterectomy, and found that sacrospinous hysteropexy was non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments for surgical failure of the apical compartment at 1 year of follow-up. In this study, 5-year outcomes on recurrent prolapse of the uterus or vaginal vault (apical compartment) in 204 women that underwent sacrospinous hysteropexy of vaginal hysterectomy with suspension of the uterosacral ligaments in the SAVE U trial are reported. Based on an intention-to-treat analysis, researchers found that surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in 16% of patients after sacrospinous hysteropexy as compared to 26% of patients after vaginal hysterectomy (difference -9.8%, 95% CI -20.9% to 1.2%). The per-protocol analysis showed that surgical failure in the apical compartment occurred in none of the women that underwent sacrospinous hysteropexy as compared to 5% of women that underwent vaginal hysterectomy (difference -5.1%, 95% CI -10.9% to 0.7%). Neither of these analyses achieved statistical significance. This study therefore shows that sacrospinous hysteropexy may be associated with improved long-term outcomes, with less anatomical recurrences of the apical compartment and/or bulge symptoms.

Click to read the study in BMJ

Image: PD

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