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A systematic review of the surgical management of apical pelvic organ prolapse

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Abstract

Introduction and hypothesis

This systematic review (PROSPERO:CRD42022275789) is aimed at comparing qualitatively the success, recurrence, and complication rates of sacrocolpopexy with concomitant hysterectomy, hysteropexy, sacrospinous fixation (SSF) with and without vaginal hysterectomy (VH) and uterosacral fixation (USF) with and without VH.

Methods

A systematic search was performed using Embase, PubMed, Scopus, and Cochrane databases for studies published from 2011, on women with apical pelvic organ prolapse requiring surgical interventions. Risk of bias was assessed via the National Institutes of Health study quality assessment tool. The primary outcomes are the success and recurrence rate of each technique, for ≥12 months’ follow-up. Findings were summarised qualitatively.

Results

A total of 21 studies were included. Overall significant findings for a high success and low recurrence rate are summarised as: minimally invasive sacrocolpopexy (MISC) is superior to abdominal sacrocolpopexy (ASC); sacrospinous hysteropexy (SSHP) is superior to USF + VH, which is superior to uterosacral hysteropexy and mesh hysteropexy (MHP). Significant findings related to complications include: MISC recorded a lower overall complication rate than ASC except in mesh exposure; USF + VH tends to perform better than SSHP and SSF, with SSHP performing better than MHP in faecal incontinence and overactive bladder rates.

Conclusion

There is no evidence to conclude that hysterectomy is superior to uterine-sparing approaches. MISC should be considered over ASC given similar efficacy and reduced complications. Superiority of MHP is unproven against native tissue hysteropexy. Further studies under standardised settings are required for direct comparisons between the surgical management methods.

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Abbreviations

AH:

Abdominal hysterectomy

ASC:

Abdominal sacrocolpopexy

CH:

Concurrent hysterectomy

FI:

Faecal incontinence

LH:

Laparoscopic hysterectomy

LSC:

Laparoscopic sacrocolpopexy

LSHP:

Laparoscopic sacral hysteropexy

LUSHP:

Laparoscopic uterosacral hysteropexy

MHP:

Mesh hysteropexy

MISC:

Minimally invasive sacrocolpopexy

OAB:

Overactive bladder

RSC:

Robotic sacrocolpopexy

SSF:

Sacrospinous fixation

SSHP:

Sacrospinous hysteropexy

SUI:

Stress urinary incontinence

USF:

Uterosacral fixation

USHP:

Uterosacral hysteropexy

UTI:

Urinary tract infection

UUI:

Urge urinary incontinence

VH:

Vaginal hysterectomy

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Authors and Affiliations

  1. Department of Surgery, Western Health, University of Melbourne, Melbourne, Victoria, Australia

    Cherie Yik Wah Chan, Royston Antony Fernandes, Henry Han-I Yao, Helen E. O’Connell & Johan Gani

  2. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

    Henry Han-I Yao

  3. Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia

    Helen E. O’Connell

  4. Department of Urology, Concord Repatriation General Hospital and University of Sydney, Concord, NSW, Australia

    Vincent Tse

  5. Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia

    Vincent Tse

  6. Department of Urology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia

    Johan Gani

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Correspondence to Cherie Yik Wah Chan.

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Chan, C.Y.W., Fernandes, R.A., Yao, H.HI. et al. A systematic review of the surgical management of apical pelvic organ prolapse. Int Urogynecol J 34, 825–841 (2023). https://doi.org/10.1007/s00192-022-05408-x

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