Kate V Meriwether1, Ethan M Balk2, Danielle D Antosh3, Cedric K Olivera4, Shunaha Kim-Fine5, Miles Murphy6, Cara L Grimes7, Ambereen Sleemi8, Ruchira Singh9, Alexis A Dieter10, Catrina C Crisp11, David D Rahn12. 1. Department of Obstetrics and Gynecology, University of Louisville, 550 S. Jackson, Ambulatory Care Building, Louisville, KY, 40202, USA. kate.meriwether@louisville.edu. 2. Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA. 3. Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA. 4. Department of Obstetrics and Gynecology, New York University, New York, NY, USA. 5. Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada. 6. The Institute for Female Pelvic Medicine & Reconstructive Surgery, North Wales, PA, USA. 7. Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA. 8. International Medical Response, Brooklyn, NY, USA. 9. Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, FL, USA. 10. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA. 11. Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH, USA. 12. Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX, USA.
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.
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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