Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse

  • Beri M. Ridgeway
    Corresponding author: Beri M. Ridgeway, MD.
    Center of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH
    Search for articles by this author
      Hysterectomy has historically been a mainstay in the surgical treatment of uterovaginal prolapse, even in cases in which the removal of the uterus is not indicated. However, uterine-sparing procedures have a long history and are now becoming more popular. Whereas research on these operations is underway, hysteropexy for the treatment of prolapse is not as well studied as hysterectomy-based repairs. Compared with hysterectomy and prolapse repair, hysteropexy is associated with a shorter operative time, less blood loss, and a faster return to work. Other advantages include maintenance of fertility, natural timing of menopause, and patient preference. Disadvantages include the lack of long-term prolapse repair outcomes and the need to continue surveillance for gynecological cancers. Although the rate of unanticipated abnormal pathology in this population is low, women who have uterine abnormalities or postmenopausal bleeding are not good candidates for uterine-sparing procedures. The most studied approaches to hysteropexy are the vaginal sacrospinous ligament hysteropexy and the abdominal sacrohysteropexy, which have similar objective and subjective prolapse outcomes compared with hysterectomy and apical suspension. Pregnancy and delivery have been documented after vaginal and abdominal hysteropexy approaches, although very little is known about outcomes following parturition. Uterine-sparing procedures require more research but remain an acceptable option for most patients with uterovaginal prolapse after a balanced and unbiased discussion reviewing the advantages and disadvantages of this approach.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wright J.D.
        • Herzog T.J.
        • Tsui J.
        • et al.
        Nationwide trends in the performance of inpatient hysterectomy in the United States.
        Obstet Gynecol. 2013; 122: 233-241
        • Frick A.C.
        • Barber M.D.
        • Paraiso M.F.
        • Ridgeway B.
        • Jelovsek J.E.
        • Walters M.D.
        Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse.
        Female Pelvic Med Reconstr Surg. 2013; 19: 103-109
        • Korbly N.B.
        • Kassis N.C.
        • Good M.M.
        • et al.
        Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.
        Am J Obstet Gynecol. 2013; 209: 470.e1-470.e6
        • American College of Obstetricians and Gynecologists
        Elective surgery and patient choice. ACOG Committee opinion no. 578.
        Obstet Gynecol. 2013; 122: 1134-1138
        • Maher C.F.
        • Cary M.P.
        • Slack M.C.
        • Murray C.J.
        • Milligan M.
        • Schluter P.
        Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12: 381-384
        • Farquhar C.M.
        • Sadler L.
        • Harvey S.A.
        • Stewart A.W.
        The association of hysterectomy and menopause: a prospective cohort study.
        BJOG. 2005; 112: 956-962
        • Moorman P.G.
        • Myers E.R.
        • Schildkraut J.M.
        • Iversen E.S.
        • Wang F.
        • Warren N.
        Effect of hysterectomy with ovarian preservation on ovarian function.
        Obstet Gynecol. 2011; 118: 1271-1279
        • Jeng C.J.
        • Yang Y.C.
        • Tzeng C.R.
        • Shen J.
        • Wang L.R.
        Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison.
        J Reprod Med. 2005; 50: 669-674
        • Costantini E.
        • Porena M.
        • Lazzeri M.
        • Mearini L.
        • Bini V.
        • Zucchi A.
        Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy.
        Int Urogynecol J. 2013; 24: 1481-1487
        • Storm H.H.
        • Clemmensen I.H.
        • Manders T.
        • Brinton L.A.
        Supravaginal uterine amputation in Denmark 1978–1988 and risk of cancer.
        Gynecol Oncol. 1992; 45: 198-201
        • Renganathan A.
        • Edwards R.
        • Duckett J.R.
        Uterus conserving prolapse surgery—what is the chance of missing a malignancy?.
        Int Urogynecol J. 2010; 21: 819-821
        • Frick A.C.
        • Walters M.D.
        • Larkin K.S.
        • Barber M.D.
        Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse.
        Am J Obstet Gynecol. 2010; 202: 507.e1-507.e4
        • Breijer M.C.
        • Peeters J.A.
        • Opmeer B.C.
        • et al.
        Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis.
        Ultrasound Obstet Gynecol. 2012; 40: 621-629
        • Romanzi L.J.
        • Tyagi R.
        Hysteropexy compared to hysterectomy for uterine prolapse surgery: does durability differ?.
        Int Urogynecol J. 2012; 23: 625-631
        • Ridgeway B.M.
        • Frick A.C.
        Uterine conservation for the surgical treatment of uterovaginal prolapse.
        in: Mark Walters Karram M. Urogynecology and reconstructive pelvic surgery. Elsevier Saunders, Philadelphia (PA)2015: 383-399
        • Dietz V.
        • van der Vaart C.H.
        • van der Graaf Y.
        • Heintz P.
        • Schraffordt Koops S.E.
        One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study.
        Int Urogynecol J. 2010; 21: 209-216
        • Gutman R.
        • Maher C.
        Uterine-preserving POP surgery.
        Int Urogynecol J. 2013; 24: 1803-1813
        • Dietz V.
        • Huisman M.
        • de Jong J.M.
        • Heintz P.M.
        • van der Vaart C.H.
        Functional outcome after sacrospinous hysteropexy for uterine descensus.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 747-752
        • Lin T.Y.
        • Su T.H.
        • Wang Y.L.
        • et al.
        Risk factors for failure of transvaginal sacrospinous uterine suspension in the treatment of uterovaginal prolapse.
        J Formos Med Assoc. 2005; 104: 249-253
        • van Brummen H.J.
        • van de Pol G.
        • Aalders C.I.
        • Heintz A.P.
        • van der Vaart C.H.
        Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms.
        Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 350-355
        • Jirschele K.
        • Seitz M.
        • Zhou Y.
        • Rosenblatt P.
        • Culligan P.
        • Sand P.
        A multicenter, prospective trial to evaluate mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse.
        Int Urogynecol J. 2015; 26: 743-748
        • Maher C.F.
        • Carey M.P.
        • Murray C.J.
        Laparoscopic suture hysteropexy for uterine prolapse.
        Obstet Gynecol. 2001; 97: 1010-1014
        • Uccella S.
        • Ghezzi F.
        • Bergamini V.
        • et al.
        Laparoscopic uterosacral ligaments plication for the treatment of uterine prolapse.
        Arch Gynecol Obstet. 2007; 276: 225-229
        • Diwan A.
        • Rardin C.R.
        • Kohli N.
        Uterine preservation during surgery for uterovaginal prolapse: a review.
        Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17: 79-83
        • Barranger E.
        • Fritel X.
        • Pigne A.
        Abdominal sacrohysteropexy in young women with uterovaginal prolapse: long-term follow-up.
        Am J Obstet Gynecol. 2003; 189: 1245-1250
        • Rosenblatt P.L.
        • Chelmow D.
        • Ferzandi T.R.
        Laparoscopic sacrocervicopexy for the treatment of uterine prolapse: a retrospective case series report.
        J Minim Invasive Gynecol. 2008; 15: 268-272
        • Leron E.
        • Stanton S.L.
        Sacrohysteropexy with synthetic mesh for the management of uterovaginal prolapse.
        BJOG. 2001; 108: 629-633
        • Demirci F.
        • Ozdemir I.
        • Somunkiran A.
        • Doyran G.D.
        • Alhan A.
        • Gul B.
        Abdominal sacrohysteropexy in young women with uterovaginal prolapse: results of 20 cases.
        J Reprod Med. 2006; 51: 539-543
        • Moiety F.M.
        • Hegab H.M.
        • Ghanem I.A.
        • Zedan W.M.
        • Salem H.A.
        Abdominal sacrohysteropexy for uterovaginal prolapse: a prospective study on 33 cases.
        Arch Gynecol Obstet. 2010; 281: 631-636
        • Krause H.G.
        • Goh J.T.
        • Sloane K.
        • Higgs P.
        • Carey M.P.
        Laparoscopic sacral suture hysteropexy for uterine prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17: 378-381
        • Tan-Kim J.
        • Menefee S.A.
        • Luber K.M.
        • Nager C.W.
        • Lukacz E.S.
        Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy.
        Int Urogynecol J. 2011; 22: 205-212
        • Rahmanou P.
        • Price N.
        • Black R.S.
        • Jackson S.R.
        Pregnancy post-laparoscopic hysteropexy.
        J Obstet Gynaecol. 2014; 11: 1-2