AUA 2009: Uterus-Sparing Surgery for Prolapse Shows Long-Term Success

Martha Kerr

May 03, 2009

May 3, 2009 (Chicago, Illinois) — Results from a 5-year follow-up study of women with uterine prolapse who underwent hysterocolposacropexy show that the uterus can be kept intact with no recurrence of uterine prolapse requiring repeat intervention.

"Repair is our prime objective with this technique. Hysterectomy is completely avoidable," lead investigator Elisabetta Costantini, MD, of the Department of Urology at the University of Perugia, Italy, announced here at the 2009 annual meeting of the American Urological Association (AUA).

Dr. Costantini presented long-term results in 47 patients with symptomatic pelvic organ prolapse who underwent uterus-sparing surgery. Forty underwent abdominal hysterocolposacropexy (HSP) and 7 underwent laparoscopic hysterocolposacropexy (LHSP). Patients were evaluated at 1, 3, 6, and 12 months postoperatively and then annually for a median of 60.7 months (range, 12 – 141 months).

Objective success was defined as the cervix or vaginal apex remaining well supported more than 6 cm above the hymen plane and no vaginal prolapse greater than or equal to grade 2 at any vaginal site during a Valsalva's maneuver. Subjective success was absence of symptoms related to prolapse or incontinence.

"No one developed a recurrence of prolapse that required another surgery," Dr. Costantini told Medscape Urology.

An anterior compartment prolapse (cystocele) of grade 2 or greater occurred in 6 (12.76%) of the 47 patients and a posterior compartment prolapse (rectocele) grade 2 or greater developed in 4 (8.51%) of the 47 patients. "No one required a further surgery to correct the recurrence," Dr. Costantini reported. "In all cases, these were too small to require [reintervention]."

Postoperative voiding symptoms persisted in 3 (6.38%) of 33 patients. Postoperative storage symptoms persisted in 6 (18.75%) of 32 patients. Two patients reported de novo urgency. Four patients reported de novo urinary incontinence. Sexual activity was maintained in 28 (95.5%) of 29 patients. Forty of 47 patients reported satisfaction with the surgical outcome.

"Our patients are asking for a uterus-sparing procedure," Dr. Costantini said. "Hysterectomy has been the only approach used up until now. But patient preference is important to us. Some of our patients are wanting to maintain fertility and other women have other reasons for wanting to keep their organs. We show that this technique is safe and feasible and has long-term success."

Dr. Costantini said there was no difference in morbidity between hysterectomy and hysterocolposacropexy.

AUA spokesman Tomas Griebling, MD, of the Department of Urology at the University of Kansas School of Medicine in Kansas City, said in an interview with Medscape Urology that "this is a very new, very revolutionary approach. Hysterectomy has always been the first and only thought.

"Patient involvement in the decision-making process is increasing," Dr. Griebling said. "These women are young and have long life expectancies and may even want to try to conceive.... When I saw this abstract among all of those submitted, I thought it was very impressive." Dr. Griebling is a member of the AUA Foundation and was involved in the development of the AUA annual meeting program.

Dr. Costantini and Dr. Griebling have disclosed no relevant financial relationships.

American Urological Association (AUA) 104th Annual Scientific Meeting: Abstract 1355. Presented April 29, 2009.

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