Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques
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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Population-based studies suggest a protective effect of hysterectomy on POP reoperation rates up to 7 years after index surgery.
“By contrast, population-based studies suggest a protective effect of hysterectomy on POP reoperation rates up to 7 years after index surgery.57,67,68”
From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [68]
The majority of women in the VUE uterine preservation arm received a vaginal uterine suspension procedure, which is known to be associated with a high failure rate.
“The majority received a vaginal uterine suspension procedure, yet this technique is known to be associated with a high failure rate [16].”
From Laparoscopic sacrohysteropexy versus vaginal hysterectomy and apical suspension: 7-year follow-up of a randomized controlled trial (2022) · cites this paper as [16]
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- Authors
- Husby, K. R., Larsen, M. D., Lose, G., & Klarskov, N.
- Affiliations
- University of Copenhagen (DK)
- University of Southern Denmark (DK)
- Corresponding author
- Husby, Karen Ruben
- Venue
- International Urogynecology Journal
- Published
- 2019-05-03
- Volume
- 30
- Issue
- 11
- Pages
- 1887-1893
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W2942573671
- Cited by
- 44
- References
- 14
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 8 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 6 · 2019: 1 · 2013: 1
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- apical prolapse, vaginal hysterectomy, sacrospinous hysteropexy, prolapse recurrence, reoperation, uterus-preserving surgery
- MeSH terms
- Aged, Female, Humans, Hysterectomy, Vaginal, Middle Aged, Recurrence, Reoperation, Gynecologic Surgical Procedures, Uterine Prolapse, Vagina
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