A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function.
OBJECTIVE
To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function.


METHODS
Randomised trial.


METHODS
Three teaching hospitals in The Netherlands.


METHODS
Eighty-two patients undergoing surgical correction of uterine prolapse stages II-IV.


METHODS
Participating patients completed the urogenital distress inventory (UDI), before and at six weeks, six months and one year after surgery, to measure discomfort of prolapse and micturition symptoms. Domain scores of the UDI (ranging from 0 to 100, higher scores indicating more discomfort) were compared between groups at all time points. Findings at pelvic examination, number of doctor visits within the first year after surgery because of pelvic floor symptoms and performed or planned surgery of recurrent genital prolapse were also compared.


METHODS
Domain scores of the UDI at one year after surgery.


RESULTS
At one year after surgery, scores on the discomfort/pain domain (mean difference 7.1, 95% confidence interval [CI] 1.1-13.2), overactive bladder domain (mean difference 8.7, 95% CI 0.5-16.9) and obstructive micturition domain (mean difference 10.3, 95% CI 0.6-20.1) of the UDI were significantly higher in the abdominal group than in the vaginal group. Findings at pelvic examination were similar in both groups. Doctor visits because of pelvic floor symptoms were more frequent in the abdominal group than in the vaginal group. Re-operation was performed or planned in 9 of the 41 patients who underwent abdominal surgery and in 1 of the 41 patients who underwent vaginal surgery (odds ratio [OR] = 11.2, 95% CI 1.4-90.0).


CONCLUSIONS
Our findings suggest that vaginal hysterectomy with anterior and/or posterior colporraphy is preferable to abdominal sacro-colpopexy with preservation of the uterus as surgical correction in patients with uterine prolapse stages II-IV.
Roovers
Jan-Paul W R
JP
Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands.
van der Vaart
C Huub
CH
van der Bom
Johanna G
JG
van Leeuwen
Jules H Schagen
JH
Scholten
Piet C
PC
Heintz
A Peter M
AP
D020884:Colpotomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D012008:Recurrence; D012086:Reoperation; D013536:Suture Techniques; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology; D014596:Uterine Prolapse / Q000503:physiopathology / Q000601:surgery*