Uterine-preserving surgeries for the repair of pelvic organ prolapse

a systematic review with meta-analysis and clinical practice guidelines

Kate V. Meriwether, Ethan M. Balk, Danielle D. Antosh, Cedric K. Olivera, Shunaha Kim-Fine, Miles Murphy, Cara L. Grimes, Ambereen Sleemi, Ruchira Singh, Alexis A. Dieter, Catrina C. Crisp, David D Rahn

Research output: Contribution to journalReview article

5 Citations (Scopus)

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.

Original languageEnglish (US)
JournalInternational Urogynecology Journal
DOIs
StatePublished - Jan 1 2019

Fingerprint

Pelvic Organ Prolapse
Practice Guidelines
Meta-Analysis
Confidence Intervals
Urinary Retention
Odds Ratio
Prolapse
Operative Time
Hysterectomy
Reoperation
MEDLINE
Databases
Recurrence

Keywords

  • Hysteropexy
  • Prolapse
  • Risks
  • Surgery
  • Systematic review
  • Uterine preservation

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

Cite this

Uterine-preserving surgeries for the repair of pelvic organ prolapse : a systematic review with meta-analysis and clinical practice guidelines. / Meriwether, Kate V.; Balk, Ethan M.; Antosh, Danielle D.; Olivera, Cedric K.; Kim-Fine, Shunaha; Murphy, Miles; Grimes, Cara L.; Sleemi, Ambereen; Singh, Ruchira; Dieter, Alexis A.; Crisp, Catrina C.; Rahn, David D.

In: International Urogynecology Journal, 01.01.2019.

Research output: Contribution to journalReview article

Meriwether, Kate V. ; Balk, Ethan M. ; Antosh, Danielle D. ; Olivera, Cedric K. ; Kim-Fine, Shunaha ; Murphy, Miles ; Grimes, Cara L. ; Sleemi, Ambereen ; Singh, Ruchira ; Dieter, Alexis A. ; Crisp, Catrina C. ; Rahn, David D. / Uterine-preserving surgeries for the repair of pelvic organ prolapse : a systematic review with meta-analysis and clinical practice guidelines. In: International Urogynecology Journal. 2019.
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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.",
keywords = "Hysteropexy, Prolapse, Risks, Surgery, Systematic review, Uterine preservation",
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T1 - Uterine-preserving surgeries for the repair of pelvic organ prolapse

T2 - a systematic review with meta-analysis and clinical practice guidelines

AU - Meriwether, Kate V.

AU - Balk, Ethan M.

AU - Antosh, Danielle D.

AU - Olivera, Cedric K.

AU - Kim-Fine, Shunaha

AU - Murphy, Miles

AU - Grimes, Cara L.

AU - Sleemi, Ambereen

AU - Singh, Ruchira

AU - Dieter, Alexis A.

AU - Crisp, Catrina C.

AU - Rahn, David D

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Hysteropexy

KW - Prolapse

KW - Risks

KW - Surgery

KW - Systematic review

KW - Uterine preservation

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