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  • Review Article
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Uterus preservation in pelvic organ prolapse surgery

Nature Reviews Urology volume 7, pages 626–633 (2010)Cite this article

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Abstract

Attitudes to sexuality and the psychological value of reproductive organs have changed in Western countries over the last few decades. Nevertheless, repair of pelvic support defects with concomitant hysterectomy is still considered the standard treatment for pelvic organ prolapse. Over the last 10 years, however, interest has been growing in uterus-sparing surgery, which can be divided into vaginal, abdominal, and laparoscopic procedures. The majority of studies on uterus-sparing surgery, with the exception of abdominal techniques, report few cases with short follow-up. Sacrospinous hysteropexy is the most studied vaginal technique for uterus preservation and favorable results have been demonstrated, although the majority of studies are flawed by selection and information bias, short follow-up and lack of adequate control groups. Abdominal and laparoscopic procedures are promising, providing similar functional and anatomical results to hysterectomy and sacrocolpopexy. Consensus is growing that the uterus can be preserved at the time of pelvic reconstructive surgery in appropriately selected women who desire it. The results of comparison trials and prospective studies confirm that uterus-sparing surgery is feasible and is associated with similar outcomes to hysterectomy, as well as shorter operating times. Surgeons should be ready to respond to the wishes of female patients who want to preserve vaginal function and the uterus.

Key Points

  • Pelvic organ prolapse (POP) is estimated to affect nearly half of all females over 50 years of age and has a negative impact on quality of life

  • Treatment depends on factors such as the severity or grade of POP, symptoms, the patient's general condition and expectations, and the surgeon's experience

  • In the last few years, a number of studies have described successful anatomical and functional outcomes after uterus-preserving POP repair in young and elderly women

  • Sacrospinous hysteropexy is the most studied vaginal technique for uterus preservation and favorable results have been demonstrated

  • Abdominal and laparoscopic approaches appear promising, providing similar functional and anatomical results to hysterectomy and sacrocolpopexy

  • Consensus is growing that the uterus can be preserved at the time of pelvic reconstructive surgery in appropriately selected women who desire it

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Figure 1: Abdominal hysteropexy procedure: anterior mesh.
Figure 2: Abdominal hysteropexy procedure: posterior mesh.

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  1. Urology and Andrology Department, University of Perugia, S. M. Misericordia Hospital, S. Andrea delle Fratte, 06100, Perugia, Italy

    Alessandro Zucchi, Massimo Lazzeri, Massimo Porena, Luigi Mearini & Elisabetta Costantini

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A. Zucchi, M. Lazzeri and E. Costantini contributed to researching data, discussing content and writing the article. M. Porena and L. Mearini provided substantial contribution towards discussion of content and reviewed the manuscript before submission.

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Correspondence to Alessandro Zucchi.

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Zucchi, A., Lazzeri, M., Porena, M. et al. Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol 7, 626–633 (2010). https://doi.org/10.1038/nrurol.2010.164

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