Comparison between laparoscopic sacrocolpopexy with hysterectomy and hysteropexy in advanced urogenital prolapse
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ORIGINAL ARTICLE
Comparison between laparoscopic sacrocolpopexy with hysterectomy and hysteropexy in advanced urogenital prolapse Ester Illiano 1 & Konstantinos Giannitsas 2 & Elisabetta Costantini 1 Received: 11 November 2019 / Accepted: 11 February 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The aim of this study was to compare the outcomes in women who underwent laparoscopic sacrocolpopexy (LSC) with or without hysterectomy for pelvic organ prolapse (POP). Methods This was a single-centre prospective study. We included women with symptomatic POP (III–IV stage) who underwent LSC with or without hysterectomy. The preoperative evaluation included a history, clinical examination and urodynamic test; all patients completed FSFI, UDI-6 and IIQ-7 questionnaires. They were followed up at 1, 3, 6 and 12 months after surgery and then annually thereafter with the same preoperative flow chart. At the last visit, they also completed the PGI-I questionnaire. Results Between 2012 and 2016, a total of 136 patients with POP were included (82 in the LSC with hysterectomy group and 54 in the hysteropexy group). At a median follow-up of 65.3 months (36–84 months), there were improvements in the anatomical and functional outcomes of both groups without differences between the two approaches. The apical success rate was 100% in all women, without recurrence in either group; the anterior and posterior success rates of hysterectomy were higher than those of uterine preservation. Conclusion This study showed that there were no differences in the anatomical and functional outcomes between LSC with or without hysterectomy for POP. Keywords Sacrocolpopexy . Laparoscopic sacrocolpopexy . Uterine preservation . Hysterectomy . Hysteropexy . Pelvic organ prolapse
Introduction In previous years, the surgical treatment for pelvic organ prolapse (POP), in particular uterine prolapse, has been pelvic support correction by hysterectomy. Although the current trend is changing, whether the uterus should be preserved is still under debate for reasons related to the surgeon, the patient, and the organ itself. The literature is limited and full of contradictions, which does not help surgeons make this decision. Few studies have compared abdominal hysterectomy and abdominal hysteropexy [1–4], and only two have used laparoscopic approaches [4, 5]. These studies had short * Ester Illiano [email protected] 1
Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Piazzale di Joanuccio 1, Posta Code 05100 Terni, Italy
2
Department of Urology, University Hospital of Patras, Rio, Greece
follow-up periods; of these studies, one was a retrospective study [4], and the author of the other study performed subtotal hysterectomy [5]. The majority of studies compared vaginal hysteropexy and vaginal hysterectomy [6–11] or the abdominal and vaginal routes [12]. The aim of this study was to compare the long-term anatomical and functional outcomes of laparoscopic hysterec
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