Vaginal surgery for uterine descent; which options do we have? A review of the literature.

Several vaginal procedures are available for treating uterine descent. Vaginal hysterectomy is usually the surgeon's first choice. In this literature review, complications, anatomical and symptomatic outcomes, and quality of life after vaginal hysterectomy, sacrospinous hysteropexy, the Manchester procedure, and posterior intravaginal slingplasty are described. All procedures had low complication rates, except posterior intravaginal slingplasty, with a tape erosion rate of 0-21%. Minimal anatomical success rates regarding apical support ranged from 85% and 93% in favor of the Manchester procedure. Data on symptomatic cure and quality of life are scarce. In studies comparing vaginal hysterectomy with sacrospinous hysteropexy or the Manchester procedure, vaginal hysterectomy had higher morbidity. Because no randomized, controlled trials have been performed comparing these surgical techniques, we can not conclude that one of the procedures prevails. However, one can conclude from the literature that vaginal hysterectomy is not the logical first choice.