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Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines

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Abstract

Introduction and hypothesis

We aimed to systematically review the literature on pelvic organ prolapse (POP) surgery with uterine preservation (hysteropexy). We hypothesized that different hysteropexy surgeries would have similar POP outcomes but varying adverse event (AE) rates.

Methods

MEDLINE, Cochrane, and clinicaltrials.gov databases were reviewed from inception to January 2018 for comparative (any size) and single-arm studies (n ≥ 50) involving hysteropexy. Studies were extracted for participant characteristics, interventions, comparators, outcomes, and AEs and assessed for methodological quality.

Results

We identified 99 eligible studies: 53 comparing hysteropexy to POP surgery with hysterectomy, 42 single-arm studies on hysteropexy, and four studies comparing stage ≥2 hysteropexy types. Data on POP outcomes were heterogeneous and usually from <3 years of follow-up. Repeat surgery prevalence for POP after hysteropexy varied widely (0–29%) but was similar among hysteropexy types. When comparing sacrohysteropexy routes, the laparoscopic approach had lower recurrent prolapse symptoms [odds ratio (OR) 0.18, 95% confidence interval (CI) 0.07–0.46), urinary retention (OR 0.05, 95% CI 0.003–0.83), and blood loss (difference −104 ml, 95% CI −145 to −63 ml) than open sacrohysteropexy. Laparoscopic sacrohysteropexy had longer operative times than vaginal mesh hysteropexy (difference 119 min, 95% CI 102–136 min). Most commonly reported AEs included mesh exposure (0–39%), urinary retention (0–80%), and sexual dysfunction (0–48%).

Conclusions

Hysteropexies have a wide range of POP recurrence and AEs; little data exist directly comparing different hysteropexy types. Therefore, for women choosing uterine preservation, surgeons should counsel them on outcomes and risks particular to the specific hysteropexy type planned.

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Acknowledgments

This work is supported by the Society of Gynecologic Surgeons (SGS), whose members comprise the Systematic Review Group (SRG) performing this review. SGS supports the SRG with provision of meeting space and oversight, and aids in the public dissemination of study findings to its members. SGS funds Dr. Balk as a paid methodological consultant.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Louisville, 550 S. Jackson, Ambulatory Care Building, Louisville, KY, 40202, USA

    Kate V. Meriwether

  2. Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA

    Ethan M. Balk

  3. Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA

    Danielle D. Antosh

  4. Department of Obstetrics and Gynecology, New York University, New York, NY, USA

    Cedric K. Olivera

  5. Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada

    Shunaha Kim-Fine

  6. The Institute for Female Pelvic Medicine & Reconstructive Surgery, North Wales, PA, USA

    Miles Murphy

  7. Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA

    Cara L. Grimes

  8. International Medical Response, Brooklyn, NY, USA

    Ambereen Sleemi

  9. Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, FL, USA

    Ruchira Singh

  10. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA

    Alexis A. Dieter

  11. Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH, USA

    Catrina C. Crisp

  12. Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX, USA

    David D. Rahn

Authors
  1. Kate V. Meriwether
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  2. Ethan M. Balk
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  3. Danielle D. Antosh
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  4. Cedric K. Olivera
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  5. Shunaha Kim-Fine
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  6. Miles Murphy
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  7. Cara L. Grimes
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  8. Ambereen Sleemi
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  9. Ruchira Singh
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  10. Alexis A. Dieter
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  11. Catrina C. Crisp
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  12. David D. Rahn
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Corresponding author

Correspondence to Kate V. Meriwether.

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Conflicts of interest

KVM is a textbook editor for Elsevier publications and has not yet received any royalties for that publication. The other authors have no conflicts to disclose.

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Study Registration

Registration with PROSPERO (CRD42017067899) and full protocol can be found at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017067899

Paper Presentation Information

Society of Gynecologic Surgeons Annual Scientific Meeting, San Antonio, TX, USA, 26–29 March 2017

Appendix 1: literature search strategy

Appendix 1: literature search strategy

Among the Medical Subject Headings (MeSH) searched were uterine prolapse, pelvic organ prolapse, prolapse, descensus, vaginal prolapse, pelvic floor, rectocele, cystocele, sacrocolpopexy, sacropexy, colpopexy, hysteropexy, uterine preservation, Manchester, colpocleisis, Fothergill, LeFort, randomized trial, longitudinal studies, clinical trial, controlled clinical trial, comparative study, prospective study, retrospective study, meta-analysis, and systematic review. Included studies could be in any published format (e.g., journal article, abstract, poster) as long as data could be extracted from the form in which it was published. We did not attempt to identify unpublished articles or abstracts, and we did not contact study authors. The search was limited to humans and included any language. Studies in languages that were not fluently read by one of our group members were interpreted with the assistance of a fluent speaker in the medical field or with professional translational software to extract relevant findings. Reference lists of selected articles and review papers were screened for additional eligible references.

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Meriwether, K.V., Balk, E.M., Antosh, D.D. et al. Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines. Int Urogynecol J 30, 505–522 (2019). https://doi.org/10.1007/s00192-019-03876-2

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