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Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques

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A Commentary to this article was published on 23 May 2019

Abstract

Introduction and hypothesis

Uterine prolapse is a common diagnosis. Today no consensus exists on which operation technique is ideal to treat apical prolapse. Vaginal hysterectomy (VH) with suspension of the vaginal cuff is the most frequently used. The popularity of uterus-preserving techniques is increasing. The aim of this study was to compare the efficiency of vaginal native tissue operations to treat primary apical prolapse, evaluated on risk of relapse surgery.

Methods

Data were obtained from the Danish National Patient Registry (NPR), which contains all operations performed in Denmark. Patients operated on for primary apical prolapse in Denmark 2010–2016 were included and followed until 2017. Clinical data were obtained from the Danish Urogynecological Database. Patients who were previously hysterectomized or operated on for prolapse in the apical compartment were excluded. Data were analyzed using Cox proportional hazard regression analysis and adjusted for age, BMI, smoking, preoperative prolapse stage and previous POP operations.

Results

In total, 7247 operations were included. The hazard ratio (HR) for relapse operation in the apical compartment was significantly higher after sacrospinous hysteropexy (SH) compared with the Manchester-Fothergill procedure (MP) [40.2 confidence interval (CI) 21.6–74.7] and VH (8.5 CI: 6.0–12.1). Likewise, the HR was higher in the anterior compartment after SH compared with MP (4.3 CI: 2.9–6.4) and VH (2.8 CI: 2.0–4.0). No convincing difference was found in the posterior compartment. The 5-year reoperation rates were 30%, 7% and 11% after SH, MP, and VH, respectively.

Conclusions

Sacrospinous hysteropexy has exceedingly high numbers of reoperations due to prolapse recurrence.

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Abbreviations

ASA:

The American Society of Anesthesiologists

BMI:

Body mass index

DugaBase:

The Danish Urogynecological Database

MP:

Manchester-Fothergill procedure

SH:

Sacrospinous hysteropexy

UI:

Urinary incontinence

VH:

Vaginal hysterectomy

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Karen Ruben Husby, Gunnar Lose & Niels Klarskov

  2. University of Copenhagen, Copenhagen, Denmark

    Karen Ruben Husby, Gunnar Lose & Niels Klarskov

  3. Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark

    Michael Due Larsen

  4. Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark

    Michael Due Larsen

Authors
  1. Karen Ruben Husby
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  2. Michael Due Larsen
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  3. Gunnar Lose
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  4. Niels Klarskov
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Corresponding author

Correspondence to Karen Ruben Husby.

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Conflict of interest

KR Husby, MD Larsen and G Lose have no disclosures. N Klarskov has received funding from Astellas Pharma and Contura outside the study.

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Husby, K.R., Larsen, M.D., Lose, G. et al. Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques. Int Urogynecol J 30, 1887–1893 (2019). https://doi.org/10.1007/s00192-019-03950-9

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  • DOI: https://doi.org/10.1007/s00192-019-03950-9

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