title: Functional outcome after pelvic floor reconstructive surgery with or without concomitant hysterectomy.
abstract: OBJECTIVE
  When counseling patients about surgical alternatives for pelvic organ prolapse (POP) repair, numerous things have to be considered. Uterine preservation vs. hysterectomy is one relevant issue. Hysterectomy has been traditionally performed for POP, but its benefit regarding outcome has never been proven. Furthermore, a growing number of women ask for uterine preservation.
  
  
  METHODS
  In this retrospective cohort study, 384 patients who had undergone surgery for POP between 2000 and 2012 at Freiburg University Medical Center were included. Using a standardized questionnaire, further surgeries, urinary incontinence, recurrent POP, pessary use, and satisfaction with the surgical outcome were evaluated. The functional results after uterine preservation vs. concomitant hysterectomy were compared using t test.
  
  
  RESULTS
  196 (51.04%) women were available for follow-up and agreed to participate (n = 122 with hysterectomy, n = 72 with uterine-preserving surgery, respectively). After a mean follow-up time of 67 months, vaginal bulge symptoms and urinary incontinence did not differ between treatment groups. We observed higher success rates and satisfaction scores in the uterine-preserving group. Regarding satisfaction with surgery and whether the patients thought it had been successful, we observed a trend toward better results in the uterine-preserving group (mean satisfaction score: 8.45 ± 2.15 vs. 7.76 ± 2.91, range 0-10, p = 0.061; success: 91.4 vs. 81.7 %, p = 0.087).
  
  
  CONCLUSIONS
  There was no difference with regard to functional outcome between patients with or without concomitant hysterectomy. Satisfaction with the operation was slightly higher after uterus preserving surgery. Therefore, uterine-preserving surgery is a valuable option unless there are contraindications.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany, juliane.farthmann@uniklinik-freiburg.de.
authors.forename: Juliane
authors.initials: J
authors.lastname: Farthmann
authors.forename: Dirk
authors.initials: D
authors.lastname: Watermann
authors.forename: Thalia
authors.initials: T
authors.lastname: Erbes
authors.forename: Katrin
authors.initials: K
authors.lastname: Roth
authors.forename: Petia
authors.initials: P
authors.lastname: Nanovska
authors.forename: Gerald
authors.initials: G
authors.lastname: Gitsch
authors.forename: Boris
authors.initials: B
authors.lastname: Gabriel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010570:Pessaries; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000601:surgery; D014599:Uterus / Q000601:surgery