Sacrospinous hysteropexy offers a uterus-preserving alternative for treating uterine prolapse, researchers from the Netherlands report.
What the Re-Search Says:
“This study shows that (based on short-term follow-up) women can avoid hysterectomy and opt for uterus preservation when uterine prolapse needs to be surgically corrected,” Dr. Renee J. Detollenaere, from Isala, Zwolle, and Radboud University Nijmegen Medical Center, the Netherlands, told Reuters Health by email. “However, patient preferences/characteristics should be taken into account and longer follow-up is necessary to confirm non-inferiority after a longer follow-up period.”
Vaginal hysterectomy is the most common surgical procedure in the 11% to 20% of women who develop uterine prolapse over the course of their lifetime, although uterus-preserving procedures are becoming increasingly popular alternatives.
Vaginal sacrospinous hysteropexy involves attachment of the uterus to the sacrospinous ligament, and retrospective cohort studies have shown it to be “as effective as vaginal hysterectomy, with shorter operating time, less blood loss, faster recovery, and fewer complications.”
Dr. Detollenaere and colleagues from four nonuniversity teaching hospitals compared sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in a randomized trial of 208 women with uterine prolapse stage 2 or higher (uterine prolapse 1 cm above the hymen or beyond).
The primary outcome, overall anatomical failure, did not differ significantly between sacrospinous hysteropexy (50%) and vaginal hysterectomy (44%), according to the July 23 BMJ online report.
In an analysis of the different compartments, more women in the vaginal hysterectomy group (14%) than in the sacrospinous hysteropexy group (4%) experienced anatomical recurrences in the posterior vaginal wall. There were no notable differences in the other compartments.
There were two serious adverse events after vaginal hysterectomy and three after sacrospinous hysteropexy, but none was related to the type of surgery.
The two groups did not differ in functional outcomes or quality of life. Pain scores were worse in the sacrospinous hysteropexy group, but only on day 14 after surgery.
Reoperation rates for recurrent pelvic organ prolapse did not differ between the two groups.
“Uterus preservation is non-inferior to vaginal hysterectomy and women who require surgical correction of uterine prolapse should be given the opportunity to choose uterus preservation and avoid hysterectomy,” Dr. Detollenaere concluded.
Dr. Kelly Jirschele, from the University of Chicago/NorthShore University HealthSystem, Skokie, Illinois, recently evaluated the use of mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse. She told Reuters Health by email that while sacrospinous hysteropexy should not become the standard treatment for uterine prolapse, “hysteropexy should remain an option for management of pelvic organ prolapse in women.”
Dr. Jirschele concluded, “There are surgical options for management of uterovaginal prolapse beyond hysterectomy.”
The Isala Research Foundation supported this research. Three coauthors reported relationships with pharmaceutical companies.
SOURCE: BMJ 2015. References: Reuters Health
Can You Skip the Hysterectomy? A New Option for Uterine Prolapse
Uterine prolapse affects up to 20% of women over their lifetime, and the most common treatment has long been vaginal hysterectomy. But a lesser-known alternative is stepping into the spotlight: sacrospinous hysteropexy. This uterus-preserving procedure could offer similar outcomes with fewer complications and a faster recovery.
A study from the Netherlands published in BMJ compared sacrospinous hysteropexy with the traditional vaginal hysterectomy, and the results might change how we approach pelvic organ prolapse.
What Is Sacrospinous Hysteropexy?
This minimally invasive procedure involves attaching the uterus to a strong pelvic ligament called the sacrospinous ligament. Unlike a hysterectomy, which removes the uterus entirely, this method keeps the uterus in place and simply lifts and secures it.
Doctors often recommend it for women with stage 2 or higher uterine prolapse, which means the uterus has descended at least to the level of the vaginal opening.
What the Study Found
Researchers followed 208 women undergoing either sacrospinous hysteropexy or vaginal hysterectomy across four Dutch hospitals. They found:
- No significant difference in overall anatomical failure between the two groups
- Fewer posterior vaginal wall recurrences in the hysteropexy group (4%) compared to the hysterectomy group (14%)
- Similar quality of life outcomes between both procedures
- Slightly more short-term pain after hysteropexy (mostly around day 14 post-op)
- No major differences in reoperation rates for recurrent prolapse
Are There Any Downsides?
While sacrospinous hysteropexy had comparable outcomes, it’s not entirely without risks. Some patients reported short-term pain, and like any pelvic surgery, there’s a chance of recurrence. However, the study noted that none of the serious adverse events in either group were directly caused by the type of surgery performed.
Why This Matters for Women’s Health
For decades, a hysterectomy was seen as the go-to solution for uterine prolapse. But that narrative is changing. As more women express a desire to preserve their uterus—whether for hormonal, emotional, or sexual health reasons—procedures like sacrospinous hysteropexy are filling an important gap.
“Women who require surgical correction of uterine prolapse should be given the opportunity to choose uterus preservation and avoid hysterectomy,” said lead author Dr. Renee Detollenaere.
What Experts Are Saying
Dr. Kelly Jirschele from the University of Chicago adds, “Hysteropexy should remain an option for management of pelvic organ prolapse in women.”
As pelvic floor health becomes a bigger part of the women’s health conversation, access to uterus-sparing surgeries could empower more women to make informed decisions.
Quick Tip
Ask your doctor about uterus-preserving options if you’re considering surgery for uterine prolapse. Not all surgeons offer sacrospinous hysteropexy, but it may be worth seeking a specialist who does.
More from Healthy Living Magazine
- How Hormonal Changes Affect Pelvic Health
- The Future of Women’s Surgery: Less Invasive, More Empowering
- What Every Woman Should Know About Hysterectomy Alternatives
Additional Resources
- BMJ Original Study
- Cleveland Clinic: Uterine Prolapse Overview
- Mayo Clinic: Pelvic Organ Prolapse Treatments
Olivia Davis
Olivia brings smart, simple ideas to everyday life — helping you live better with less effort.
