V2-11: High uterosacral hysteropexy for the management of pelvic organ prolapse
Hysterectomy at the time of pelvic organ prolapse repair is controversial. Uterine preserving procedures for prolapse repair may be beneficial as this allows preservation of fertility, body image and sexual function and potentially avoids an unnecessary procedure. In this video, we present our technique for transvaginal high uterosacral hysteropexy as an alternative mesh-free uterine-preserving procedure for prolapse repair and analyse our institutional outcomes.
This video illustrates a step by step video sequence of our technique for high uterosacral hysteropexy in a patient with symptomatic Stage III pelvic organ prolapse. We also performed a single institution, single surgeon retrospective analysis of patients treated by either high uterosacral hysteropexy or hysterectomy with high uterosacral suspension for their prolapse between 2013 and 2015. Institutional Review Board approval was obtained. We directly compared operative blood loss, pre-operative POP Q evaluation with post-operative POP Q evaluation as well as pre and post-operative American Urologic Association (AUA) Symptom scores in these 2 groups.
Surgery time was 3 hours 24 minutes. No immediate or early complications were noted and repair was successful on follow up. The outcomes of 20 patients were assessed and summarized in the table below. Nine patients underwent high uterosacral hysteropexy alone and 11 patients underwent hysterectomy and high uterosacral suspension. Follow up was for a minimum of 6 months. Blood loss was significantly reduced in the high uterosacral hysteropexy cohort (mean: 88mls vs 232mls, p=0.004) and there was no difference in post-operative AUA symptoms scores or POP Q evaluation between the 2 treatment groups.
We present our technique of high uterosacral hysteropexy and show that this results in a significantly reduced blood loss compared to non uterine-preserving techniques and comparable post-operative outcomes suggesting that this a suitable option for pelvic organ prolapse management.