Modified Purandare’s cervicopexy versus abdominal sacral hysteropexy as conservative surgeries for genital prolapse: a randomized controlled trial

Abstract

Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, is a common condition. Many women with prolapse experience symptoms that impact daily activities, sexual function, and exercise. The incidence of uterine prolapse in young women of reproductive age is low. The incidence rises for young women who have delivered one or two children. As this type of prolapse occurs at a younger age, the surgical technique should not only reduce the prolapse but also retain the reproductive function. Abdominal sacral hysteropexy with mesh is the gold standard regarding conservative surgery for apical prolapse. However, the modified Purandare's cervicopexy remains a valuable alternative with low-risk profile and high success rate. Patients and methods. Thirty patients of reproductive age suffering from apical prolapse were randomized into two groups to undergo either modified Purandare's cervicopexy or abdominal sacrohysteropexy with mesh as a conservative surgery for apical prolapse. The primary outcome measure was the operative time of both surgeries with the exclusion of any concomitant procedures. Other measures of outcome included recurrence of prolapse, which was assessed 3, 6 and 12 months after the procedure, intraoperative blood loss, need for blood transfusion, and intraoperative complications. Postoperative pain was assessed during the first 24 hours after surgeries using the visual analogue scale as well as the postoperative hospital stay. Results. The operative time in minutes was significantly shorter among the modified Purandare's cervicopexy group compared to the abdominal sacral hysteropexy group (77.1 ± 6.8 vs. 94.2 ± 7.5 with p-value = 0.001). There was no significant difference between the two groups regarding the postoperative recurrence of symptoms with only one case in the modified Purandare's cervicopexy group experiencing recurrence one year after the procedure. There was no significant difference detected between the two groups regarding neither the intraoperative blood loss nor the need for blood transfusion with p-values of 0.094 and 0.999, respectively. No significant difference between the two groups existed regarding the intraoperative and postoperative complications. Postoperative pain and postoperative hospital stay were measured as well with no significant difference between the study groups. Conclusion. Abdominal sacral hysteropexy with mesh is the gold standard regarding conservative surgery for apical prolapse. However, the modified Purandare's cervicopexy remains an attractive alternative with low-risk profile and high success rate. It can be beneficial in certain conditions like obese patients, patients with medical history of abdominal surgeries, in whom it is difficult to access the retroperitoneum and anterior longitudinal ligament of the sacrum due to adhesions from past surgeries. Key words: pelvic organ prolapse, apical prolapse, modified Purandare's cervicopexy, abdominal sacral hysteropexy