Uterine Conservation During Prolapse Repair

摘要

OBJECTIVES: The primary aim is to compare safety and long-term outcomes between uterine-sparing prolapse procedures performed using 4 different surgical routes over a 9-year period. METHODS: This is a retrospective cohort study of women who underwent uterine-sparing prolapse procedures performed by 10 female pelvic medicine and reconstructive surgeons between January 2003 and December 2011. Demographic information, operative characteristics, complications (intraoperative and postoperative), and prolapse recurrence were obtained by chart review. Additional information collected included subsequent uterine or cervical pathology, procedures, and pregnancies. RESULTS: Two hundred forty uterine-sparing prolapse procedures were performed in the 9-year period. One hundred two patients (42.5%) underwent a vaginal procedure, 95 patients (39.6%) underwent a conventional laparoscopic procedure, 28 patients (11.7%) underwent a robotic-assisted laparoscopic procedure, and 15 patients (6.3%) underwent an abdominal procedure. Median follow-up time and interquartile range for abdominal, vaginal, laparoscopic, and robotic surgical routes were 16.4 (3.9-23.9), 14 (3.3-36.4), 22.6 (2.9-64.5), and 6.1 (3-24.4) months, respectively. Prolapse recurrence rates were similar for all groups (abdominal 13.3%, vaginal 14.7%, laparoscopic 11.6%, robotic 3.6%; P = 0.39). Intraoperative, postoperative, and long-term complications rates were similar between all groups (P = 0.63, P = 0.43, P = 0.10). The rate of benign gynecologic conditions encountered after surgery was similar among all groups, with an overall rate of abnormal uterine bleeding/postmenopausal bleeding of 5.4% and overall rate of cervical dysplasia of 0.8%. Two pregnancies were reported, both undergoing cesarean delivery at term. CONCLUSIONS: Uterine-sparing prolapse procedures appear to have good long-term safety and a low risk of future gynecologic pathology.