Search Results (8)

Background: Nowadays, there is an increasing desire among women suffering from pelvic organ prolapse (POP) to choose a uterus-sparing surgical treatment in order to preserve their fertility. The objective of this study was to conduct a systematic review of the literature to assess how pregnancy and delivery affect the recurrence of POP in women who had previously undergone laparoscopic hysteropexy as well as to improve and individualise the future counselling of patients of reproductive age desiring uterine-preserving treatment for POP. Methods: A comprehensive literature review was conducted using the MEDLINE (PubMed), Web of Science, and Scopus databases for articles published until January 2025, without previous historical limits. The research strategy adopted included different combinations of the following terms: hysteropexy, pregnancy, laparoscopy, and prolapse. Results: A total of ten case reports and three case series met the inclusion criteria for the review, comprising 26 patients. All authors used laparoscopic sacral hysteropexy (LSHP) for the treatment of POP. All patients underwent caesarean delivery at a mean gestational age of 38 weeks. Over a mean follow-up period of 9 months, only 4% of patients developed a recurrent uterine prolapse. A total of 8% of the patients developed de novo anterior compartment prolapse, 8% developed a recurrence of anterior compartment prolapse, and 4% developed posterior compartment prolapse. Conclusions: LSHP seems to be a safe option for women of reproductive age with incomplete family planning, as it does not seem to negatively impact foetal growth. Pregnancy does not appear to affect the long-term efficacy of hysteropexy in maintaining apical support. Given the limited data on the safety and efficacy of uterine-sparing surgery for POP followed by a subsequent pregnancy, further evidence is of great importance towards evaluating safety, efficacy, and providing better counselling for women. Full article

Background: Pelvic organ prolapse (POP) is a common disorder among postmenopausal women but is rare in very young patients. It can affect various compartments of the pelvic floor. In severe forms, vaginal/uterine and rectal prolapse can occur concurrently. Methods: The aim of this report is to present a rare case of a young patient with an extreme postpartum uterine and rectal prolapse and our stepwise surgical approach to achieve complete repair while preserving the ability to carry future pregnancies. Results: A 31-year-old patient was admitted with extreme postpartum uterine and rectal prolapse. She underwent three separate surgeries to regain full anatomic reconstruction. Initially, laparoscopic lateral suspension (LLS) according to Dubuisson’s technique was performed in 2017. A combined vaginal-laparoscopic repair followed again in 2017 and included extensive posterior vaginal and perineal repair with absorbable mesh (SeraSynth) attached to the sacrouterine ligaments and laparoscopic hysterosacropexy (HySa) with a non-absorbable PVDF DynaMesh-CESA implant. Finally, in 2019, the DynaMesh-CESA implant was replaced with a T-shaped non-absorbable Albis Posterior Mesh for rectal prolapse, fixed bilaterally to the sacral bone at the S3 level. Additionally, the Dubuisson suspension was adjusted using Noé’s pectopexy for the implant’s reattachment to the pectineal ligaments. Conclusions: Severe uterine and rectal prolapse in young patients is rare and demands a tailored approach. Uterus-preserving surgery should be the priority. In the present case, a resorbable posterior mesh failed in rectal prolapse repair, while a combined rectal prolapse repair and hysteropexy with a non-resorbable posterior mesh proved effective. Full article

Background/Objectives: Surgical repair of apical prolapse most commonly includes hysterectomy. However, nowadays, the number of women who seek uterine preserving surgical treatment is increasing. Our objective is to review the current evidence on laparoscopic hysteropexy techniques, outcomes and appropriate patient selection. Methods: A literature search was carried out in MEDLINE/PubMed and ClinicalTrials.gov databases. The search was restricted to humans, female patients and currently used surgical procedures. Results: Laparoscopic hysteropexy was found to be associated with good anatomic outcomes, symptom improvement and low complication or reoperation rates. Conclusions: Laparoscopic hysteropexy appears to be a good alternative option for women who undergo surgical treatment for apical prolapse and desire preservation of the uterus. However, further prospective comparative studies, as well as longer follow-up periods, are necessary for evaluating long-term safety and efficacy outcomes of the method. Full article

(1) Background: Pelvic organ prolapse (POP) affects millions of women globally, impacting their quality of life and potentially influencing family planning decisions. This study aimed to assess the impact of uterus-preserving prolapse surgery on the sexual function, desire for children, and pregnancy outcomes in premenopausal women with symptomatic POP. (2) Methods: A survey study was conducted among patients who underwent sacrospinous hysteropexy at a tertiary hospital between 2001 and 2021. Telephone interviews were performed to gather data on sexual function, desire for children, and satisfaction with surgical outcomes. (3) Results: The study included 33 premenopausal women, revealing diverse factors influencing sexual activity and desire for children following surgery. While most of the participants expressed a desire for children after surgery, sexually inactive individuals were more likely to report an unfulfilled desire for children. Fear of incontinence during sexual activity emerged as a significant concern for the sexually inactive participants. (4) Conclusions: The study highlights the need for comprehensive counselling and tailored interventions to address the multifaceted needs of women with POP. Further research is warranted to highlight the long-term implications of uterus-preserving surgeries on women’s health and well-being. Full article

Although it is known that hysterectomy (HY) alone cannot resolve apical prolapse, vaginal hysterectomy (VH) remains the most common surgical procedure for this issue. In recent years, various procedures for uterine conservation have been proposed to avoid the surgical risks of HY. Furthermore, most women with symptomatic pelvic organ prolapse (POP) prefer uterine conservation in the absence of considerable benefit in uterine removal. In 2017, we proposed a new technique for hysteropexy and anterior vaginal native tissue repair (NTR) in women with cystocele and apical prolapse. The objective of this study is to assess the efficacy and safety of this new procedure after at least 5 years of follow-up. We included only patients with stage II or greater prolapse of the anterior vaginal wall and a concomitant stage II uterine prolapse in accordance with Pelvic Organ Prolapse Quantification (POP-Q) system. A Patient Global Impression of Improvement (PGI-I) score ≤ 2 in addition with the absence of POP symptoms was defined as subjective success. A descensus with a maximum point of less than −1 in any compartment was considered objective cure. A total of 102 patients who fulfilled the inclusion criteria were enrolled. At 60 months follow-up, 90 out of 102 patients (88%) were subjectively cured, whereas 88 out of the 102 (86%) patients were objectively cured. Subjective and objective cure rates persisted during the entire study period. Uni- and multivariate analysis of possible predictive factors associated with recurrence of prolapse showed that only a preoperative point C > 0 cm and BMI ≥ 25 kg/m² were risk factors for failure. In conclusion, our study showed that hysteropexy with anterior vaginal native tissue repair may be an effective and safe option for the treatment of anterior vaginal prolapse and concomitant stage II uterine prolapse by at least 5 years of follow-up. Full article

Background. Pelvic organ prolapse (POP) is a common health problem, with a high lifetime risk for prolapse surgery. Uterine-preserving procedures such as vaginal sacrospinous hysteropexy (SSH) have become an increasingly utilized surgical option for the primary treatment of POP. We wanted to evaluate peri- and postoperative outcome parameters of SSH as an alternative to vaginal hysterectomy with apical fixation. Methods. A retrospective cohort study was conducted (2003–2021). All patients who underwent primary SSH (study group) for symptomatic POP were matched 1:1 by age and BMI with patients who underwent primary prolapse hysterectomy with apical fixation (control group). Results. A total of 192 patients were included with 96 patients in the each of the SSH and hysterectomy groups. There were no statistically significant differences in baseline characteristics. The SSH group show a significantly shorter mean surgery time (p < 0.001), significantly fewer hospitalization days (p < 0.001), and significantly less intraoperative blood loss (p = 0.033) in comparison to the control group. Neither group had any intraoperative complication, or an intraoperative conversion to other surgical management options. No statistically significant difference was found in postoperative complications as categorized by the Clavien–Dindo classification or in postoperative urogynecological issues (UTI, de-novo, incontinence, residual urine, voiding disorders). Through log regression, none of the confounding factors such as age, BMI, or preoperative POP-Q stage could be identified as independent risk factors for the occurrence of postoperative complications. Conclusions. Our results confirm that a uterus-preserving technique has many benefits and, thus, should be considered as an additional intermediate step in a long-term treatment plan of pelvic organ prolapse. Full article

The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)—61; laparoscopic pectopexy (LP)—53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP. Full article

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. Methods: In this single-center retrospective cohort study, women who underwent vaginal total hysterectomy for POP between 2014 and 2016 were collected. The cervical and total uterine lengths were measured by pathologists, while the ratio of cervical length to total uterine length were calculated. The cervical elongation is defined as corpus/cervix ratio ≤ 1.5. Results: A total of 133 patients were enrolled in this study. Among these patients, 43 women had cervical elongation and 90 women had normal length of uterine cervix. We found that age > 65 years old (67.4% vs. 42.2%, p = 0.007), total vaginal length ≥ 9.5 cm (65.1% vs. 45.6%, p = 0.035), uterine weight < 51 gm (72.1% vs. 52.2%, p = 0.03), and Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) ≥ 12 (30.2% vs. 14.4%, p = 0.032) were associated with the risk of cervical elongation. There were no significant differences on preoperative urodynamic parameters in the two groups. Conclusion: The patient age > 65 years old, the total vaginal length of POP-Q system ≥ 9.5 cm, uterine weight < 51 g, and POPDI-6 ≥ 12 are independent risk factors of cervical elongation in women with POP. For women scheduled for pelvic reconstructive hysteropexy, concomitant cervical amputation should be considered. Full article