Uterine Preservation Surgery Research Articles

Placenta accreta spectrum: risk factors for unplanned immediate hysterectomy in planned uterine preservation surgery.

Placenta accreta spectrum (PAS) is a term used to describe trophoblast invasion into the uterine wall. The condition can be fetal at labor due to a lack of spontaneous separation of the placenta from the uterine wall, leading to severe hemorrhage. In this study we aim to evaluate preoperative risk factors for unplanned immediate hysterectomy in PAS uterine-preserving surgeries. Preoperative parameters of women who underwent successful uterine-preserving surgery were retrospectively compared to those who underwent an unplanned immediate hysterectomy during these surgeries. A multivariable regression analysis was conducted to identify independent factors associated with unplanned immediate hysterectomy. Overall, 238 were included in the study's cohort. 86.2% underwent successful uterine-preserving surgery, and 13.8% underwent an unplanned immediate hysterectomy. The number of previous CDs and the proportion of women with grade 3 preoperative PAS was significantly lower among the successful uterine-preserving group. The proportion of preoperative ultrasound lacunae detection, the number of lacunae observed, loss of clear zone detection, the length of clear zone loss, the proportion of retroplacental hypervascularity, bridging vessels detection, and bladder involvement were significantly lower in the successful uterine-preserving group. In a multivariable regression analysis, the presence of lacunae and loss of clear zone were independently associated with unplanned cesarean hysterectomy [adjusted odds ratio (aOR) 95% confidence interval (CI) 3.18(1.11-11.6), p=0.047, and aOR 3.67 (95% CI 1.3-13.2), p=0.025, respectively]. Preoperative assessment of the applicability of a uterine-preserving surgery may be performed using the US parameters reported in this study.

Pregnancy Outcomes after Uterine Preservation Surgery for Placenta Accreta Spectrum: A Retrospective Cohort Study

Objective This study aimed to investigate maternal and neonatal outcomes in subsequent pregnancies of women with a history of placenta accreta spectrum (PAS) compared with women without history of PAS. Study Design A retrospective cohort study conducted at a single tertiary center between March 2011 and January 2022. We compared women with a history of PAS who had uterine preservation surgery and a subsequent pregnancy, to a control group matched in a 1:5 ratio. The primary outcome was the occurrence of a composite adverse outcome (CAO) including any of the following: uterine dehiscence, uterine rupture, blood transfusion, hysterectomy, neonatal intensive care unit admission, and neonatal mechanical ventilation. Multivariable logistic regression was performed to evaluate associations with the CAO. Results During the study period, 287 (1.1%) women were diagnosed with PAS and delivered after 25 weeks of gestation. Of these, 32 (11.1%) women had a subsequent pregnancy that reached viability. These 32 women were matched to 139 controls. There were no significant differences in the baseline characteristics between the study and control groups. Compared with controls, the proportion of CAO was significantly higher in women with previous PAS pregnancy (40.6 vs. 19.4%, p = 0.019). In a multivariable logistic regression analysis, previous PAS (adjusted odds ratio [aOR] = 3.31, 95% confidence interval [CI] = 1.09–10.02, p = 0.034) and earlier gestational age at delivery (aOR = 3.53, 95% CI = 2.27–5.49, p < 0.001) were independently associated with CAOs. Conclusion A history of PAS in a previous pregnancy is associated with increased risk of CAOs in subsequent pregnancies. Key Points

At the Scrub Sink: Uterine Preservation Surgery.

At the Scrub Sink: Uterine Preservation Surgery.

A novel technique for the measurement of cervical length in non-pregnant women.

Cervical elongation is considered a risk factor for pelvic organ prolapse treatment failure in uterine preservation surgery. Consensus has not been reached regarding what is considered a normal cervical length, or how to measure it. Our primary aim was to test a new technique for measuring cervical length. We enrolled women undergoing hysterectomy, with or without pelvic organ prolapse (for all indications except cervical tumours/history of cervical operations). Their cervical lengths were measured both by ultrasound and anatomical measurement. The external length of the cervix was measured using Doppler location of the uterine artery near the cervical-uterine junction as the proximal point and compared to the ultrasound measurement of the cervical canal. The uterine specimen was used to record anatomical cervical measurements as well as uterine corpus length. Baseline characteristics such as age, body mass index and pelvic organ prolapse quantification were also collected. Twenty women were eligible for evaluation. We found the average anatomical cervical canal length was (ccAN) 33.95 mm (range ± 9.23) and by external measurement (ceAN) 36.80 mm (range ± 7.54). We found a significant, high-powered correlation between our ultrasound and anatomical measurements in both techniques, as well as between the two ultrasound techniques. We also found a negative correlation between cervical length and women's age (rp = -0.443, P = 0.05). Transvaginal ultrasound measurement of cervical length using the location of the uterine artery was found to have a strong correlation to the anatomical cervical length and can be used for the measurement of normal cervical length.

Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study.

Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy. This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS. In this retrospective cross-sectional study, the records of 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women were divided into 2 groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation, or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization were compared between groups. In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent a hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine preservative surgeries in terms of the need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization. The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS.

Gender expression is associated with selection of uterine preservation or hysterectomy for pelvic organ prolapse surgery: Novel methodology for sex- and gender-based analysis in gynecologic research.

To explore whether patient characteristics were associated with gender expression, and to further determine impact of gender expression on patient selection of hysterectomy or uterine-preservation in pelvic organ prolapse (POP) surgery. Within a prospective cohort, a self-reported gender expression tool classified patients as expressing gender polar (i.e., reporting only feminine traits) or non-polar gender scores (i.e., reporting feminine and masculine traits). Multivariate modeling explored associations of gender expression with traditional socio-demographic variables, and with selection of hysterectomy or uterine-preserving surgery. Descriptive statistics of socio-demographic variables were reported by frequency, proportion and mean (SD). 177 participants completed the gender score questionnaire. Overall, the sample had a more feminine gender expression with the majority of respondents classified as gender polar (67.23%, n=119). Participants with non-polar gender scores were 2.53 times (95% 1.05-6.09) more likely to choose uterine preservation versus hysterectomy-based surgery. Gender polarity was weakly associated with age, but no other sociodemographic variables. Gender expression is not tightly associated with socio-demographic variables, and is thus a novel measurement in gynecologic research. Gender polarity appears to be associated with choice to undergo hysterectomy. Further research is required to understand this relationship and implications in clinical outcomes.

Sacrospinous fixation and vaginal uterosacral suspension: evaluation in uterine preservation surgery

To compare anatomic failure, prolapse symptoms, retreatment and incidence of peri-operative adverse events between patients undergoing vaginal uterosacral hysteropexy (USHP) and sacrospinous hysteropexy (SSHP) This was a multi-center retrospective cohort study of patients who underwent USHP or SSHP with a FPMRS surgeon between 2015 and 2019. Patients were excluded if they had no follow up greater than 6 weeks postoperatively. Anatomic failure was defined as prolapse beyond the hymen. Composite failure was defined as anatomic failure, bulge symptoms, and/or re-treatment for prolapse. At 4 sites, 147 patients underwent SSHP and 114 underwent USHP. SSHP patients were younger (62±13 vs 58±13 yrs, p=0.01) and had a higher BMI (28 vs 26 kg/m2, p=0.002) otherwise there were no differences in characteristics between groups. USHP patients were more likely to undergo concurrent anterior repair (86% vs 70%, p=0.002), posterior repair (84% vs 65%, p=0.001) and incontinence procedures (52% vs 38%, p=0.033). Operative time was longer in the USHP group (125 (105, 160) vs 91 (70, 118) min, p<0.001). 49% of USHP utilized permanent or permanent and delayed absorbable sutures, while 82% of SSHP were performed with delayed absorbable sutures (p<0.001). The 6-week follow up rate was 95% (138 SSHP and 111 USHP patients), at which time there were 4 (1.5%) anatomic failures: 1 (0.7%) SSHP and 3 (2.6%) USHP (p= 0.321) while 25 patients (9.9%) reported bulge symptoms (10%SSHP vs 9.8%USHP) and none underwent retreatment. At 1 year, the follow up rate was 32% (83/261) with no difference between groups. There were 10 (3.8%) anatomic failures: 3 (2%) SSHP and 7 (6.1%) USHP (p=0.109). There was no difference in bulge symptoms(10%), composite failure(13%) or median POP stage (2). Only 8 SSHP and 2 USHP patients had cervical elongation. 50% of the SSHP patients without trachelectomy required surgical retreatment. Of the 4 SSHP patients who underwent trachelectomy, none had retreatment for prolapse though 1 reported bulge symptoms. No USHP patients underwent partial trachelectomy or retreatment for prolapse but 1 patient had anatomic and symptomatic failure. The overall incidence of complications was low (7%) with a higher rate of ureteral kinking in the USHP group (7% vs 1.4%, p=0.023). With median follow up of 17 months, 12 patients (4.6%) underwent subsequent hysterectomy, 11 of which were for recurrent prolapse, with no difference between the groups (6.8%SSHP vs 1.8%USHP, p=0.073). Additionally, 17 patients (6.5%) underwent treatment for uterine/cervical pathology (12 SSHP vs 5 USHP, p=0.313) One year after hysteropexy, 1 in 3 patients were available for follow-up and there were no differences in prolapse recurrence between patients who underwent USHP versus SSHP. The incidence of adverse events was low and less than 5% of patients underwent subsequent hysterectomy for prolapse.

Uterine cavity evaluation after uterine preservation surgeries for morbidly adherent placenta.

The morbidly adherent placenta (MAP) is usually associated with maternal morbidity and mortality. The objective of this study was to evaluate the uterine cavity after uterine preservation surgeries for MAP. The study group comprised women ≥ 28 weeks pregnant with confirmed MAP, with a desire for future fertility, and who agreed to uterine preservation surgery for MAP. The uterine preservation surgeries done for MAP include the following: uterine artery ligation, placental-myometrial en bloc excision, and/or internal iliac artery (IIA) ligation. Participants managed by uterine preservation surgeries for MAP were evaluated 3-6 months after the surgeries using office hysteroscopies to evaluate the uterine cavity after uterine preservation surgeries (primary outcome). The secondary outcome measures the pregnancy outcome after uterine preservation surgery. The hysteroscopic examination of the uterine cavity after uterine preservation surgery for MAP showed normal uterine cavity in 36 participants (90%), while it showed abnormal uterine cavity in 4 participants (10%). The abnormal hysteroscopic findings were a single abnormal hysteroscopic finding (endometrial polyp) in 2 participants (5%) and 2 abnormal hysteroscopic findings (incompletely healed scar with unilateral tubal ostial occlusion) in 2 participants (5%). The incidence of pregnancy after uterine preservation surgeries for MAP was 7.5% (3/40). The uterine preservation surgeries for MAP in this study had no effect on menstrual pattern, uterine cavity, or future fertility. The effect of uterine preservation surgeries for MAP on menstrual pattern, uterine cavity, and future fertility should be evaluated in future larger studies.

Success Rates and Outcomes of Laparoscopic Mesh Sacrohysteropexy

Study Objective This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Design Retrospective cohort study. Setting Private Practice. Patients or Participants 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Interventions Laparoscopic mesh sacrohysteropexy. Measurements and Main Results The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Conclusion Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse. This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Retrospective cohort study. Private Practice. 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Laparoscopic mesh sacrohysteropexy. The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse.

Intrauterine balloon tamponade combined with temporary abdominal aortic balloon occlusion in the management of women with placenta accreta spectrum:a randomized controlled trial

Objective: To access the effectiveness and safety of the intrauterine balloon tamponade verse gauze packing combined with temporary abdominal aortic balloon occlusion in the management of placenta accreta spectrum (PAS). Methods: This was an open-label, randomized controlled trial conducted in Nanjing Drum Tower Hospital. The patients suspected with PAS for uterine preservation surgery under the multidisciplinary team care were recruited between Aug 2015 and Jan 2018. When bleeding could not be achieved after fetus delivered, and a temporary abdominal aortic balloon occlusion and the compression sutures as needed, the women were randomly allocated 1∶1 into balloon tamponade (n=81) or gauze packing (n=80) group. The primary outcome was successful bleeding arrests by avoiding second line surgeries. The secondary outcomes included the volume of blood loss during and after cesarean section, the rate of PPH, incidence and amount of blood transfusion, hysterectomy, postpartum pain, ICU admission, need for re-laparotomy, and the length of hospital stay, readmission, and interventional radiology complications. Results: All the women [100% (81/81)] in the balloon group were obtained hemostasis without further intervention, significantly higher than 88% (70/80) in the gauze group (P=0.001). Before uterine tamponade, blood loss were 820 ml (620-1 230) ml and 850 ml (605-1 442) ml, while placenta bed were sutured in 96%（78/81, 77/80） respectively (P>0.05).The proportion of blood loss≥1 000 ml was higher in the gauze group than that in the balloon group (P=0.006). Maternal adverse events involving total blood loss, puerperal morbidity and postpartum pain occurred more frequently in the gauze group (P<0.05). The following outcome showed no statistically significant difference between the two groups: the vascular occlusion time, the dose of radiation, and interventional radiology complication (P>0.05). The median volume infused into the lower and upper balloons is 70 ml (50-100 ml) and 180 ml (100-240 ml). Conclusions: Incrauterine balloon tamponade is as effective as gauze packing in hemostasis following the placenta delivery in PAS. Compared with gauze packing, the uterine balloon tamponade is more effective.

Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.

ObjectiveThis study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.MethodsThis retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture.ResultsThis study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications.ConclusionPlacental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.

Manchester Repair as A Uterine Preservation Surgery

Uterine preservation surgery in uterovaginal prolapse is beginning to be relooked at more vigorously now. The need for uterine preservation surgery is for the reasons of desire for future fertility, maintaining sexual function and sense of identity for the woman. Incontinence and pelvic organ prolapse (POP) have an impact on sexuality.

Uterine preservation surgery in severe postpartum haemorrhage: What impact on reproductive function?

Introduction: Postpartum haemorrhage (PPH) remains one of the most risky situations in obstetrics and major cause of maternal morbidity and mortality worldwide. There can be major psychological sequelae also. Treatment options for PPH include conservative management with uterotonic drugs, selective devascularization by ligation or embolization of the uterine artery, external compression with uterine sutures, intrauterine balloon and hysterectomy. This last issue adds to the maternal drama of a situation with definitive infertility. The choice of treatment depends on several factors: delivery mode, the site of origin and volume of bleeding, the patient's hemodynamic tolerance, the technical possibility and the surgical skills.

Choosing the uterine preservation surgery for placental polyp determined by blood flow evaluation: A retrospective cohort study.

BackgroundA placental polyp is an intrauterine polypoid mass or pedunculated mass occurring from residual trophoblastic tissue following abortion, cesarean section or vaginal delivery. Recently uterine preservation surgery represented by transcervical resection (TCR) has been performed for placental polyps. However TCR without intravascular intervention, including uterine artery embolization (UAE) may cause profound bleeding which necessitate emergency laparotomy.MethodsSeventeen cases of placental polyp were retrospectively examined. We divided cases into two groups: strong vascularity group (n = 13) and weak vascularity group (n = 4). Mass extraction of polyp by TCR was conducted in 16 cases, 6 case without UAE and 10 cases with UAE.ResultsAs for the weak vascularity group, one case was naturally resolved while planning surgery and 3 cases were treated with TCR without UAE without major intra- and/or postoperative bleeding. On the other hand in the strong vascularity group, 2 out of 3 cases of TCR without UAE resulted in major bleeding during and after the surgery, both needed transfusion and one needing postoperative UAE. Ten cases of strong vascularity group, TCR with UAE were performed and all of them were accomplished without major bleeding. TCR without UAE was safely performed in cases where there was absent or mild to moderate blood flow.ConclusionsOur report suggests that adding UAE might be safer to treat placental polyps that have strong vascularity.

Feasibility of uterine preservation in the management of early-stage uterine adenosarcomas: a single institute experience

BackgroundWe aimed to evaluate the efficacy and the safety of uterine preservation in patients with early-stage uterine adenosarcoma who want to preserve future fertility.MethodsWe performed a retrospective review of patients with stage I uterine adenosarcoma diagnosed and treated at a single institute from 1998 through 2014.ResultsAmong the total of 31 patients, uterine preservation surgery was performed in 7 of the nulliparas. Of the 7 patients receiving uterine preservation surgery, 3 showed no evidence of disease (NED), 2 had persistent disease confined to the uterus, and 2 were alive with disease (AWD) after recurrence. One patient with an NED status had a vaginal delivery at term. In the uterine preservation group, 1 patient had sarcomatous overgrowth at the time of diagnosis and experienced disease recurrence. In the hysterectomy group, 3 of 24 patients had tumor recurrence. Of the five patients with tumor recurrence, four (80%) had sarcomatous overgrowth at diagnosis and it was significantly associated with recurrence by univariate analysis (OR 13.3, p = 0.027).ConclusionsUterine preservation represents a possible treatment option for young female patients who want to maintain fertility. However, a detailed explanation of the risk of recurrence is necessary, especially in patients with sarcomatous overgrowth, which seems to be associated with a higher risk of recurrence.Trial registrationRetrospectively registered.

Peer review report 1 on “Choosing the uterine preservation surgery for placental polyp determined by blood flow evaluation: a retrospective cohort study.”

Peer review report 1 on “Choosing the uterine preservation surgery for placental polyp determined by blood flow evaluation: a retrospective cohort study.”

Peer review report 2 on “Choosing the uterine preservation surgery for placental polyp determined by blood flow evaluation: a retrospective cohort study.”

Peer review report 2 on “Choosing the uterine preservation surgery for placental polyp determined by blood flow evaluation: a retrospective cohort study.”

Laparoscopic Pectouteropexy: Alternative Technique for Uterine Preservation

Study ObjectiveTo show an alternative technique of laparoscopic pectouteropexy for uterine preservation in young women. DesignA step-by-step explanation of the technique using videos (educative video). SettingIn recent years, uterine preservation surgery for pelvic organ prolapse has become more popular. Sacrouteropexy is traditionally performed for prolapsus surgery, but the procedure continues to be associated with an increased length of stay, increased analgesic requirements, small bowel obstruction, ileus, and de novo stres urinary incontinence. An alternative technique of laparoscopic pectouteropexy has been developed for the preservation of fertility in younger women; this technique uses lateral parts of the iliopectineal ligament for a bilateral mesh fixation of the descended structures and provides strong apical support. ConclusionThe iliopectineal ligament is far from the ureter, intestine, sigmoid, and presacral veins during surgery, so the iliopectineal ligament is in a safe anatomic zone for uterine preservation surgery. Laparoscopic pectouteropexy might be an alternative technique for preservation of the uterus in young patients.

Management of uterine prolapse: is hysterectomy necessary?

Key content Management of uterine prolapse is currently heavily influenced by patient and surgeon preferences. The traditional approach to uterine prolapse is vaginal hysterectomy. However, this does not address the underlying deficiency in connective tissue pelvic floor support, and prolapse recurrence is common. Uterine preservation surgery is increasing in popularity, both with surgeons and patients; there is currently little evidence to show superior outcome to hysterectomy. Fertility preservation remains the one absolute indication for hysteropexy. Other potential advantages include stronger apical support and reduced vaginal surgery. Colpocleisis remains a valid option for a small cohort of patients. Learning objectives Options for the management of uterine prolapse. How to help patients decide on a management plan.

Laparoscopic hysteropexy: a novel technique for uterine preservation surgery

In recent years uterine preservation surgery for pelvic organ prolapse has become more popular. Traditional operations such as vaginal hysterectomy do not address the underlying pathophysiology of poor connective tissue support, which may result in a higher incidence of recurrent prolapse. This video article demonstrates uterine preservation surgery for women with uterine prolapse using laparoscopic abdominal Prolene mesh. This procedure, apart from possible preservation of fertility in younger women, provides strong apical support, which should be long lasting. The other advantages of laparoscopic surgery are quicker recovery, less pain and better cosmesis.