Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: Observational follow-up of a multicentre randomised trial
Open accessAbstract
Objective: To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery. Design: Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial. Setting: Four non-university teaching hospitals, the Netherlands. Participants: 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years. Main outcome measures: Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning. Results: At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference−6.7%, 95% confidence interval −12.8% to−0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions. Conclusions: At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures. Trial registration: trialregister.nl NTR1866.
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In the Netherlands, there is an increasing preference for uterine sparing surgery in the treatment of POP since recent studies indicate fewer anatomical recurrences, less repeat surgery, and a higher proportion of composite success when performing sacrospinous hysteropexy.
“In the Netherlands, there is an increasing preference for uterine sparing surgery in the treatment of POP since recent studies indicate fewer anatomical recurrences, less repeat surgery, and a higher proportion of composite success when performing sacrospinous hysteropexy [4].”
From The External Validation of a Multivariable Prediction Model for Recurrent Pelvic Organ Prolapse After Native Tissue Repair: A Prospective Cohort Study (2025) · cites this paper as [4]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe shift towards more uterine sparing surgery reflects the change in treatment preferences in the Netherlands because of recent studies on the results of uterine sparing surgery.
“This shift towards more uterine sparing surgery reflects the change in treatment preferences in the Netherlands because of recent studies on the results of uterine sparing surgery [4].”
From The External Validation of a Multivariable Prediction Model for Recurrent Pelvic Organ Prolapse After Native Tissue Repair: A Prospective Cohort Study (2025) · cites this paper as [4]
The Discussion (Clinical implications and future research; page unavailable) says uterus-preserving surgery is gaining popularity and links an increase in England to changing preferences. It does not establish a shift in treatment preferences in the Netherlands or say that recent outcome studies caused such a shift. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAfter sacrospinous hysteropexy, more women had the composite outcome of success than after vaginal hysterectomy with uterosacral ligament suspension.
“Furthermore, after SSH, more women had the composite outcome of success.”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [9]
At 5-year follow-up of the SAVE-U trial, significantly fewer anatomic recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy than after vaginal hysterectomy with uterosacral ligament suspension.
“At 5-year follow-up, significantly fewer anatomic recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after SSH than after VH with uterosacral ligament suspension.”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [9]
The SAVE-U trial was a large randomized controlled trial comparing sacrospinous hysteropexy with vaginal hysterectomy with uterosacral ligament suspension over a 5-year follow-up.
“The SAVE-U trial was a large randomized controlled trial (RCT) comparing the effectiveness of SSH with that of VH with uterosacral ligament suspension over a follow-up period of 5 years.9”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [9]
POP-Q point Ba is a risk factor for the composite outcome of failure after SSH or VH with uterosacral ligament suspension.
“This secondary analysis of the 5-year follow-up of the SAVE-U trial 9 demonstrated that BMI, smoking, and POP-Q point Ba are risk factors for the composite outcome of failure after SSH or VH with uterosacral ligament suspension.”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [9]
BMI is a risk factor for the composite outcome of failure after SSH or VH with uterosacral ligament suspension.
“This secondary analysis of the 5-year follow-up of the SAVE-U trial 9 demonstrated that BMI, smoking, and POP-Q point Ba are risk factors for the composite outcome of failure after SSH or VH with uterosacral ligament suspension.”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [9]
The Results (Table 1; page unavailable) list BMI as a baseline characteristic, while the Results (Table 2; page unavailable) compare failure and composite success between surgical groups. No passage found links BMI to composite failure as a risk factor (searched: BMI risk factor, body mass index, and predictors of recurrent prolapse). (LLM, conf=0.75)
Experimental — accuracy not yet measuredSmoking is a risk factor for the composite outcome of failure after SSH or VH with uterosacral ligament suspension.
“This secondary analysis of the 5-year follow-up of the SAVE-U trial 9 demonstrated that BMI, smoking, and POP-Q point Ba are risk factors for the composite outcome of failure after SSH or VH with uterosacral ligament suspension.”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [9]
The Results (Table 1; page unavailable) list smoking status as a baseline characteristic, and Table 2 reports composite outcomes by surgery group. Neither links smoking to failure risk. Searches for smoking as a risk factor or predictor found no passage establishing that association. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Schulten, S. F. M., Detollenaere, R. J., Stekelenburg, J., IntHout, J., Kluivers, K. B., & van Eijndhoven, H. W. F.
- Affiliations
- Radboud University Medical Center (NL)
- Isala (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Detollenaere, Renée J
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2019-09-10
- Volume
- 366
- Pages
- l5149
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC6734519
- OpenAlex
- W2972634607
- Cited by
- 127
- References
- 28
- Citations by year
- 2026: 16 · 2025: 14 · 2024: 20 · 2023: 16 · 2022: 26 · 2021: 18 · 2020: 14 · 2019: 1 · 2018: 1 · 2013: 1
- FWCI
- 11.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- 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
- vaginal hysterectomy, uterosacral ligament suspension, uterine prolapse, long-term surgical outcomes, reoperation, quality of life, sexual function, uterus-preserving surgery, pelvic floor surgery, pessary
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Hysterectomy, Vaginal, Ligaments, Middle Aged, Netherlands, Quality of Life, Recurrence, Reoperation, Severity of Illness Index, Suture Techniques, Uterine Prolapse, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Treatment Outcome
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