Update in fertility-sparing native-tissue procedures for pelvic organ prolapse
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CLINICAL OPINION
Update in fertility-sparing native-tissue procedures for pelvic organ prolapse Stefano Manodoro 1 & Andrea Braga 2 & Marta Barba 3 & Giorgio Caccia 2 & Maurizio Serati 4 & Matteo Frigerio 5 Received: 9 June 2020 / Accepted: 23 July 2020 # The International Urogynecological Association 2020
Abstract Uterine-sparing prolapse surgery has been gaining back popularity with clinicians and patients. Although both prosthetic and native-tissue surgery procedures are described, the latter is progressively regaining a central role in pelvic reconstructive surgery, owing to a lack of mesh-related complications. Available native-tissue procedures have different advantages and pitfalls, as well as different evidence profiles. Most of them offer anatomical and subjective outcomes comparable with those of hysterectomybased procedures. Moreover, native-tissue procedures in young women desiring childbearing allow to avoid synthetic material implantation, which may lead to potentially serious complications during pregnancy. As a consequence, we do think that offering a reconstructive native-tissue procedure for uterine preservation (with the exception of the Manchester procedure) is the safest option in women wishing for pregnancy. Sacrospinous ligament hysteropexy and high uterosacral ligament hysteropexy may be considered first-line options in consideration of the higher level of evidence and lack of adverse obstetrical outcomes. Keywords Italian language . Patient-reported outcome . Quality of life . Questionnaire . Validation
Introduction Pelvic organ prolapse (POP) is a common clinical condition in parous women. Patients may be bothered by vaginal bulging, urinary incontinence, voiding dysfunction, bowel disorders, or sexual symptoms [1, 2]. POP management involves both conservative interventions—such as pelvic floor muscle training and vaginal pessary—and surgical treatment, according to prolapse stage, symptoms, general health status, and patient preference [3]. Surgery may be offered for patients that either decline or in whom conservative management fails, and either hysterectomy-based procedures or uterus-sparing techniques can be performed. Recently, uterine-sparing surgery has been gaining back popularity with clinicians and patients. Uterus-
* Matteo Frigerio [email protected] 1
San Paolo University Hospital, Milan, Italy
2
EOC-Beata Vergine Hospital, Mendrisio, Switzerland
3
Milano Bicocca University, Monza, Italy
4
University of Insubria, Varese, Italy
5
San Gerardo University Hospital, Via Pergolesi 33, 20900 Monza, Italy
sparing procedures are associated with shorter operative time, less blood loss, and faster return to activities compared with hysterectomy [4]. Uterine preservation is attractive for patients concerned about the change in their body image and sexuality after hysterectomy, despite the lack of evidence about any positive impact of uterine preservation on female sexual function. Moreover, uterus-sparing procedures are mandatory for women wishing to preserve fertility. C
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