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Prolapse Surgery Possible Without Hysterectomy


 

CHICAGO — Uterus-sparing surgery was a safe alternative to concurrent hysterectomy for many women undergoing surgery for pelvic organ prolapse, based on mean follow-ups of 5 years.

Favorable outcomes can be achieved with uterine preservation, and women aged 40-60 years who are free of vaginal and uterine disease should know about this option, Dr. Elisabetta Costantini of the University of Perugia (Italy) and her colleagues wrote in a poster presented at the annual meeting of the American Urological Association. Leaving the uterus intact has been thought to introduce the risk for repeat surgery, yet none of the patients in this study required additional surgery.

Hysterocolposacropexy was performed in 47 women with symptomatic pelvic organ prolapse; 40 had abdominal procedures and 7 had laparoscopic procedures. Patients were followed up at 1, 3, 6, and 12 months after surgery and then yearly for a mean of 5 years (range, 12-141 months). Outcome measures included anatomical and physical examinations, assessments of urodynamics, and patient responses to questionnaires.

Sexual activity was maintained in 28 of 29 (96%) patients following surgery. None of the patients required repeat surgery for recurrent prolapse, and 83% reported long-term satisfaction with their procedures. However, anatomical examinations indicated cystocele of grade 2 or higher in six women (12.8%) and rectocele of grade 2 or higher in four (8.5%). Postoperative voiding symptoms persisted in 3 of 33 (9.1%) patients, and postoperative storage symptoms persisted in 6 of 32 (18.8%) patients. Two patients reported de novo urgency, and four patients showed de novo urinary incontinence (three with stress UI and one with urge UI). None of the patients developed pelvic neoplasms.

For younger patients, an option is to place only one posterior mesh; however, it is preferable for patients to plan not to conceive again, Dr. Costantini said during a press conference. “We should always advise them about the risks of pregnancy and delivery and the need for a long-term follow-up to rule out malignant disease.”

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