Uterus-Sparing Surgery: Outcomes of Transvaginal Uterosacral Ligament Hysteropexy

Study Objective: Recently, there has been a paradigm shift toward uterine conservation during the surgical management of pelvic organ prolapse (POP), specifically uterine prolapse. There are few reports on transvaginal uterosacral ligament hysteropexy (TULH). This study aimed to describe our surgical technique and outcomes. Design: Retrospective review and description of surgical technique. Anatomic outcome has been reported using the POP quantification system. Complications were segregated. A comparison of parametric continuous variables was performed using paired t test. Categoric variables were evaluated using the Pearson x(2) test and the Fisher exact test. A p-value <.05 was considered significant. Setting: Teaching hospital. Patients: Forty patients who underwent TULH from 2009 to 2017. Interventions: TULH. Measurements and Main Results: A total of 40 patients met the inclusion criteria. Of these, 56.1% had preoperative stage 3 prolapse. The median operative time was 116 minutes. The mean estimated blood loss was 158.5 mL. Transient ureteral obstruction occurred in 2 patients. The mean follow-up time was 17.2 months, and all patients had significant improvement of prolapse (p < .001). There was also an improvement in urinary incontinence and bladder storage symptoms (p < .001). None of the patients were reoperated on for recurrent POP. Conclusion: TULH is an effective uterus-preserving surgical alternative for the treatment of uterovaginal prolapse and provides good apical support. It is also associated with a low short-term recurrence and incidence of reoperation. TULH is a viable option for suitable patients with uterovaginal prolapse who desire uterine conservation. (C) 2020 AAGL. All rights reserved.