Hysteropexy vs hysterectomy for the surgical treatment of genital prolapse: systematic review

Summary

Summary: Pelvic organ prolapse is a common pathology worldwide. Surgical treatment generally includes a hysterectomy; However, there is no consensus among specialists about its real need. Objective: to carry out a systematic review of randomized controlled studies that compare hysteropexy vs hysterectomy, combined with some prolapse correction technique, and provide clinical recommendations. Materials and Methods: electronic search in Medline, Embase, Cochrane and Clinical Trials databases, from its start date until December 2018 of randomized controlled studies that compare hysteropexy vs hysterectomy with any prolapse repair technique, without language restriction. Results: 339 abstracts were identified using the keywords. Based on title and abstract, 23 studies were selected and of them 7 met the inclusion criteria. The quality of the evidence was moderate. Hysteropexy  has similar rates of reoperation and prolapse recurrence to hysterectomy with apical repair. In quantification of prolapse using POP-Q, hysteropexy presents a higher C point and greater total vaginal length than hysterectomy. We did not find significant differences in terms of complications between both techniques. Conclusion: hysteropexy is a safe technique, with success rates and reintervention due to recurrence similar to those of hysterectomy with apical repair. However, there is a lack of studies with longer follow-up and better quality.