Uterussparende chirurgie versus vaginale hysterectomie als behandeling van descensus uteri

Objective

To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse.

Design

Systematic review.

Method

We searched in Pubmed, Embase, the Cochrane Library and the reference lists of relevant publications for articles comparing uterus preserving procedures with vaginal hysterectomy. The following outcome measures were studied: anatomical result, subjective outcome regarding prolapse symptoms, micturition, defecation and sexual function, quality of life, duration of surgery, duration of hospital stay, amount of blood loss, complications and postoperative recovery.

Results

We found one systematic review, one randomised trial and five cohort studies, from which eight comparative studies were selected for review. There was no difference in subjective outcome after sacrospinous fixation, Manchester Fothergill procedure, abdominal hysteropexy and intravaginal slingplasty on comparison with vaginal hysterectomy. All procedures, except for sacrospinous ligament fixation, had similar anatomical outcomes to vaginal hysterectomy. With the exception of Manchester Fothergill procedure hospital stay was shorter after uterus preservation. The quality of most of the studies was poor, with only small numbers of patients included and short-term follow up.

Conclusions

Although some uterus preserving procedures are associated with shorter operation time, shorter duration of hospital stay and less blood loss than vaginal hysterectomy, based on the current literature there is no clear preference for either uterus preserving surgery or hysterectomy in surgical treatment of uterine descent, since randomised trials of sufficient quality are lacking. Prospective clinical randomised trials with long term follow-up are needed to investigate the value of uterine preserving procedures.

Conflict of interest: M. Vierhout is a member of the European Advisory Board on Overactive Bladder, sponsored by Astellas Europe. Financial support: J. den Boon received financial support for advice on mesh procedures for prolapse surgery and incidental payment from Johnson and Johnson for lectures.