Functional outcome after pelvic floor reconstructive surgery with or without concomitant hysterectomy

Area of Science:

• Urogynecology
• Pelvic Floor Surgery
• Female Pelvic Medicine

Background:

• Pelvic organ prolapse (POP) repair often involves hysterectomy, but its necessity is debated.
• Patient preference for uterine preservation in POP surgery is increasing.
• Evidence supporting hysterectomy's benefit in POP outcomes is lacking.

Purpose of the Study:

• To compare surgical outcomes of uterine preservation versus hysterectomy for pelvic organ prolapse (POP).
• To evaluate patient satisfaction and functional results after POP surgery with or without hysterectomy.

Main Methods:

• Retrospective cohort study of 384 patients undergoing POP surgery (2000-2012).
• Follow-up via standardized questionnaire assessing further surgeries, urinary incontinence, recurrent POP, pessary use, and satisfaction.
• Comparison of functional results between uterine preservation and hysterectomy groups using t-tests.

Main Results:

• 196 patients (51.04%) completed follow-up (122 hysterectomy, 72 uterine preservation).
• No significant differences in vaginal bulge symptoms or urinary incontinence between groups after a mean of 67 months.
• Trend towards higher success rates (91.4% vs. 81.7%) and satisfaction scores (8.45 vs. 7.76) in the uterine-preserving group.

Conclusions:

• Uterine preservation surgery is a viable option for POP repair, offering similar functional outcomes to hysterectomy.
• Patients undergoing uterus-preserving surgery reported slightly higher satisfaction.
• Uterine preservation should be considered unless contraindications exist.