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A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function
Jan-Paul W R Roovers1, C Huub van der Vaart, Johanna G van der Bom
1Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands.
BJOG : an International Journal of Obstetrics and Gynaecology
|December 23, 2003
Summary
Vaginal hysterectomy with colporraphy is a better surgical option for uterine prolapse than abdominal sacro-colpopexy, showing improved urogenital function and fewer reoperations. This study compared surgical outcomes for pelvic floor repair.
Area of Science:
- Urogynecology
- Pelvic reconstructive surgery
Background:
- Uterine prolapse affects many women, impacting quality of life.
- Surgical correction is often necessary for stages II-IV prolapse.
- Comparing surgical approaches is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare the efficacy of vaginal hysterectomy with colporraphy versus abdominal sacro-colpopexy in treating uterine prolapse.
- To assess the impact of each surgical method on urogenital function and patient-reported outcomes.
Main Methods:
- A randomized trial involving 82 patients with uterine prolapse (stages II-IV) across three Dutch hospitals.
- Urogenital Distress Inventory (UDI) scores were collected pre-surgery and at 6 weeks, 6 months, and 1 year post-surgery.
- Pelvic examination findings, doctor visits for pelvic floor symptoms, and reoperation rates were also compared.
Main Results:
- At one year, patients undergoing vaginal hysterectomy reported significantly lower discomfort/pain, overactive bladder, and obstructive micturition symptoms compared to the abdominal group.
- Pelvic examination findings were similar between groups.
- The abdominal surgery group experienced more frequent doctor visits and a significantly higher rate of reoperation for recurrent prolapse.
Conclusions:
- Vaginal hysterectomy with anterior and/or posterior colporraphy is a preferable surgical treatment for uterine prolapse (stages II-IV) compared to abdominal sacro-colpopexy.
- The vaginal approach demonstrates superior outcomes in urogenital function and lower rates of surgical failure.