Abstract
Introduction and hypothesisSurgical management of uterine prolapse varies greatly and recently uterus-preserving techniques have been gaining popularity. The aim of this study was to compare patient-reported outcomes after cervical amputation versus vaginal hysterectomy, with or without concomitant anterior colporrhaphy, in women suffering from pelvic organ prolapse.MethodWe carried out a population-based longitudinal cohort study with data from the Swedish National Quality Register for Gynecological Surgery. Between 2006 and 2013, a total of 3,174 patients with uterine prolapse were identified, who had undergone primary surgery with either cervical amputation or vaginal hysterectomy, with or without concomitant anterior colporrhaphy. Pre- and postoperative prolapse-related symptoms and patient satisfaction were assessed, in addition to complications and adverse events. Between-group comparisons were performed using univariate and multivariate logistic regression.ResultsThere were no differences between the two groups in neither symptom relief nor patient satisfaction. In both groups a total of 81 % of the women reported the absence of vaginal bulging 1 year after surgery and a total of 89 % were satisfied with the result of the operation. The vaginal hysterectomy group had a higher rate of severe complications than the cervical amputation group, 1.9 % vs 0.2 % (p < 0.001). The vaginal hysterectomy group also had a longer duration of surgery and greater perioperative blood loss, in addition to longer hospitalization.ConclusionsCervical amputation seems to perform equally well in comparison to vaginal hysterectomy in the treatment of uterine prolapse, but with less morbidity and a lower rate of severe complications.
Highlights
Introduction and hypothesisSurgical management of uterine prolapse varies greatly and recently uterus-preserving techniques have been gaining popularity
The aim of the present study was to compare the outcomes of cervical amputation versus vaginal hysterectomy, with or without concomitant anterior vaginal wall repair, in women suffering from uterine prolapse, using a population-based cohort selected from a national quality register
The two groups differed in that the patients with a symptomatic recurrence were somewhat younger and had a higher body mass index (BMI) compared with the patients with Bcured prolapse.^ There were no statistical differences when comparing the two groups considering the severity of prolapse in the apical or anterior compartment, functional status (ASA classification), parity, or whether or not concomitant anterior colporrhaphy was performed
Summary
Introduction and hypothesisSurgical management of uterine prolapse varies greatly and recently uterus-preserving techniques have been gaining popularity. Uterus-preserving techniques have been shown to be associated with less morbidity and shorter hospitalization [8] and it has been suggested that hysterectomy causes damage to the vascular and nerve supply of the pelvis, resulting in bladder dysfunction and recurrence of prolapse [9, 10]. Procedures such as abdominal sacrocolpopexy and sacrospinous fixation have been evaluated in randomized trials and have shown high success rates in comparison to
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