title: Anatomic outcomes after pelvic-organ-prolapse surgery: comparing uterine preservation with hysterectomy.
abstract: OBJECTIVE
  Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11-19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses.
  
  
  METHODS
  In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u-test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse.
  
  
  RESULTS
  Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90min; p=0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse (p>0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p=0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery.
  
  
  CONCLUSIONS
  Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses.
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria. Electronic address: julian.marschalek@meduniwien.ac.at.
authors.forename: Julian
authors.initials: J
authors.lastname: Marschalek
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Trofaier
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Guelen
authors.initials: G
authors.lastname: Yerlikaya
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Engelbert
authors.initials: E
authors.lastname: Hanzal
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Koelbl
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ott
authors.affiliation: Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institut fuer spezielle Gynaekologie und Geburtshilfe, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Umek
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D016015:Logistic Models; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology; D014599:Uterus / Q000502:physiology / Q000601:surgery*
keywords: Hysterectomy; Natural orifice surgery; Organ preservation; Pelvic organ prolapse; Sacrospinous ligament fixation