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Abdominal Sacral Hysteropexy: A Pilot Study Comparing Sacral Hysteropexy to Sacral Colpopexy With Hysterectomy

Cvach, Kristina MD; Geoffrion, Roxana MD; Cundiff, Geoffrey W. MD

Female Pelvic Medicine & Reconstructive Surgery: September/October 2012 - Volume 18 - Issue 5 - p 286–290
doi: 10.1097/SPV.0b013e3182673772
Original Articles

Objectives: Treatment of pelvic prolapse with uterine conservation using the sacral hysteropexy may be associated with less patient morbidity but has uncertain subjective and objective outcomes. We sought to compare abdominal sacral hysteropexy (ASH) with sacral colpopexy/total abdominal hysterectomy (ASC/TAH).

Methods: This is an ambispective (retrospective/prospective) cohort pilot study comparing ASH to ASC/TAH. The primary outcome was global impression of improvement. Secondary outcomes were based on validated quality-of-life questionnaires and surgical complications.

Results: Eighteen ASHs were compared to 9 ASC/TAHs after a mean follow-up of 19 months. Whereas subjective outcomes did not differ, anterior failure (55%) and subsequent uterine pathology (22%) were higher in the ASH cohort. Graft erosion occurred in 33% of the ASC/TAH group.

Conclusions: The ASH offers advantages and disadvantages that warrant further investigation with a prospective study.

Our study indicates that whilst sacral hysteropexy may reduce the risk of mesh erosion compared to sacral colpopexy with noncomitant hysterectomry, the trade-offs are the potential increased risk of recurrent anterior compartment prolapse and the future risk of uterine or cervical pathology.

From the *Department of Urogynecology, Mercy Hospital for Women, Melbourne, Australia; and †Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.

Reprints: Kristina Cvach, MD, Mercy Hospital for Women, 163 Studley Rd, Heidelberg Victoria 3084, Australia. E-mail: kcvach@smartchat.net.au.

The authors declare that they have nothing to disclose.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.