Evaluation of Transvaginal Uterosacral Ligament Hysteropexy vs. Uterosacral Ligament Suspension with Hysterectomy: A Retrospective Comparison Study with Two Year Outcomes
Raffee SM, Kachroo N, Elshatanoufy S, and Atiemo H. Evaluation of Transvaginal Uterosacral Ligament Hysteropexy vs. Uterosacral Ligament Suspension with Hysterectomy: A Retrospective Comparison Study with Two Year Outcomes. Neurourol Urodyn 2019; 38:S241-S242.
Introduction: Pelvic organ prolapse affects many women with an 12.6% lifetime risk of requiring surgical intervention. There has been growing interest in the efficacy of uterine preservation for uterovaginal prolapse. Many studies to date have evaluated sacrospinous hysteropexy and sacral hysteropexy as surgical options for uterine preservation techniques for the correction of uterovaginal prolapse. There is paucity in the data regarding uterosacral ligament hysteropexy (USLH). The objective of this study was to evaluate the two year outcomes of utererosacral ligament hysteropexy in comparison to uterosacral ligament suspension with hysterectomy in terms of operative data, anatomical efficacy and patient satisfaction. Methods: A retrospective chart review was performed on patients that underwent a high uterosacral hysteropexy or uterosacral ligament suspension with hysterectomy between 2013 and 2016 by a single provider. Patient demographics, baseline and follow-up POP-Q exam, operative data and patient satisfaction scores were evaluated with descriptive statistics. Results: The USLH group included 14 patients and the hysterectomy group included 13 patients. Please see Table 1 for patient demographic information. Mean estimated blood loss was 75.4 cc for the USLH and 209.6 cc for the hysterectomy group (p=0.001). 64% of the USLH group followed up at 21.6 months or later while only 46.2% of the hysterectomy group followed up at more than 22.3 months. At this follow-up point, 8/9 in the USLH group had stage 2 or less prolapse and 6/6 had stage 2 or less prolapse in the hysterectomy group. Reoperation was required in 2/14 in the USLH group with these patients having preoperative stage 3 and 4 prolapse. The mean Pelvic Floor Distress Inventory 20 (PFDI-20) questionnaire scores showed no statistical significance between the patients that followed up at this time interval. Conclusion: Transvaginal uterosacral ligament hysteropexy appears to provide comparable results to uterosacral ligament suspension with hysterectomy. Though this study was limited by its small sample size and limited patient follow-up, there is evidence that results are durable at 2 years for those that do not have high grade preoperative prolapse.