Sacrospinous Hysteropexy Versus Vaginal Hysterectomy: Long-term Outcomes

Uterine-preserving surgery is an increasingly popular alternative to the traditional use of hysterectomy with vaginal vault suspension to treat pelvic organ prolapse with native tissue. However, comparative evidence remains limited.

This study aimed to compare the long-term recurrence rates of symptomatic apical pelvic organ prolapse treated with vaginal hysterectomy versus sacrospinous hysteropexy.

A retrospective, single-center, cohort study was conducted from 2011 to 2024, including 100 women with symptomatic primary pelvic organ prolapse (Pelvic Organ Prolapse Quantification stage ≥2) who underwent native-tissue repair through either vaginal hysterectomy (n = 51) or sacrospinous hysteropexy (n = 49). The primary endpoint was prolapse recurrence, defined as a composite of subjective vaginal bulge symptoms and/or surgical retreatment.

The average follow-up was 100.1 months for the hysterectomy group and 51.8 months for the hysteropexy group. Prolapse recurrence occurred in 33% of the total sample: 10 patients (19.6%) in the hysterectomy group versus 23 patients (46.9%) in the hysteropexy group (P = 0.007). Kaplan-Meier analysis showed that hysteropexy had a significantly higher and earlier rate of recurrence compared with hysterectomy. In the multivariable Cox model, hysteropexy still showed a higher risk of recurrence (hazard ratio, 5.37; 95% CI, 2.28-12.65; P < 0.001).

Sacrospinous hysteropexy showed a significantly higher rate and an earlier onset of recurrence compared with conventional vaginal hysterectomy. While uterine-preserving surgery is a growing trend, caution is warranted when counseling patients regarding its long-term durability relative to hysterectomy in native-tissue repairs.