Cervicocolpopexy Safe, Effective in Uterine Prolapse

Laurie Barclay, MD

March 31, 2003

March 31, 2003 — Cervicocolpopexy was safe and effective and had fewer complications than vaginal hysterectomy for uterine prolapse, according to the results of a nonrandomized prospective trial published in the March issue of the American Journal of Obstetrics and Gynecology.

"Vaginal hysterectomy concomitantly with the repair of pelvic support defects is still considered the standard practice for correction of uterovaginal prolapse, despite descent of the uterus itself being a result, not the cause, of prolapse," write M. Hefni, FRCOG, from Benenden Hospital in Kent, U.K., and colleagues.

Vaginal hysterectomy is not without risks, especially in elderly women who are poor surgical candidates. Sacrospinous cervicocolpopexy with uterine conservation may therefore have theoretical advantages. "If this operation alone could relieve symptoms and restore uterine and upper vaginal support, then the addition of another major operative procedure (ie, vaginal hysterectomy) in a surgically vulnerable age group would be unnecessary," the authors write.

Between February 1996 and January 2001, 109 women with a complaint of symptomatic uterovaginal prolapse received either sacrospinous cervicocolpopexy (56%) or vaginal hysterectomy with sacrospinous colpopexy (44%). Mean age was 70.1 ± 6 years in the cervicocolpopexy group and 69.4 ± 4.6 years in the hysterectomy group.

The former group did better than the latter group in terms of less blood loss (P < .01), shorter operating time (P < .01), and fewer complications after surgery (P = .01). After a mean follow-up period of 33 to 34 months, outcomes were similar in both groups for uterine and upper vaginal support (93.5% vs. 95.9%), recurrent cystocele (11.4% vs. 10.4%), and repeat surgery for recurrent uterovaginal or vault prolapse (5% vs. 4.2%).

Study limitations included the lack of validation of the quality of life assessment and the lack of randomization.

"Sacrospinous cervicocolpopexy with uterine conservation is a safe and effective surgical option that could benefit elderly patients with uterovaginal prolapse. It avoids the potential morbidity of vaginal hysterectomy and is associated with a high success rate," the authors write. "It remains to be assessed whether uterine conservation has, in addition, long-term anatomic advantage through preservation of the integrity of the pericervical endopelvic fascia. Larger numbers of patients and longer follow-up are needed to test this hypothesis. Such a study, in a randomized setting, is currently underway."

Am J Obstet Gynecol. 2003;188:645-650

Reviewed by Gary D. Vogin, MD

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