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Comparisons of Functional Apical Support After Sacral Hysteropexy Versus Sacral Colpopexy

A Cadaveric Study

Maldonado, Pedro A., MD; Jackson, Lindsey A., MD; Florian-Rodriguez, Maria E., MD; Wai, Clifford Y., MD

Female Pelvic Medicine & Reconstructive Surgery: January 4, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000682
Original Article: PDF Only
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Objectives Prolapse procedures with uterine preservation offer an alternative to colpopexy with hysterectomy. Few studies have examined the differences in anatomic or subjective outcomes following sacral hysteropexy versus sacral colpopexy with hysterectomy. This study sought to compare the ability of sacral hysteropexy and sacral colpopexy with hysterectomy to resist downward traction as an estimate of apical support in human cadavers.

Methods Sacral hysteropexy was performed on unembalmed female cadavers. A metal bolt/washer was threaded through the uterine fundus, down the cervical canal. and out the vagina and fastened to a waxed surgical filament, which ran over a fixed pulley at the table's end. Successive weights were added to provide increasing loads on the uterine fundus, and the distances traversed by the fundus were recorded. The same process was repeated after completion of a total hysterectomy (with vaginal cuff closure) and subsequent sacral colpopexy in the same specimen. Data were analyzed using paired-sample t test and repeated-measures analysis of variance (Sigma Plot version 13.0), with P ≤ 0.05 considered statistically significant.

Results Eight female cadavers were utilized. With the addition of each weight, the average distance traversed by the uterine fundus or vaginal cuff gradually increased. There were no statistical differences in the distances moved by the apex between sacral hysteropexy and total hysterectomy/sacral colpopexy.

Conclusions These results suggest that functional support provided by sacral hysteropexy and sacral colpopexy with hysterectomy may be similar. Further studies are needed to correlate these findings with patient satisfaction, which may vary despite similar anatomic results.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.

Correspondence: Pedro A. Maldonado, MD, Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX 79905. E-mail: pedro.maldonado@ttuhsc.edu.

The authors have declared they have no conflicts of interest.

All work was completed at the University of Texas Southwestern Medical Center in Dallas, TX. P.A.M. has since moved institutions.

This study was presented at the 42nd Annual Scientific Meeting of the Society of Gynecologic Surgeons; Palm Springs, CA; April 10 to 13, 2016.

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