title: Long-term outcome of native tissue reconstructive vaginal surgery for advanced pelvic organ prolapse at 86 months: Hysterectomy versus hysteropexy.
abstract: OBJECTIVE
  To evaluate and compare the long-term outcome of sacrospinous ligament fixation (SSF) in combination with various other compartment defect native tissue repairs with hysterectomy or hysteropexy.
  
  
  METHODS
  Medical records of 159 patients who underwent surgery for pelvic organ prolapse (POP) between April 2004 and August 2008 were reviewed retrospectively. Patients were assessed at baseline and at 5-year postoperative follow-up. SSF, anterior (AC) and posterior colporrhaphy (PC), both with and without hysterectomy, were performed. Primary outcome was objective cure (POP quantification system [POP-Q] ≤1) and subjective cure (negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6 [POPDI-6]). Subanalysis was done on patients who had uterus preserved compared with those with vaginal hysterectomy.
  
  
  RESULTS
  Postoperative data were available for 146 patients: 120 in the hysterectomy group and 26 in the hysteropexy group. Mean age, parity, postmenopausal status and mean operating time in the hysterectomy group were significantly higher than in the hysteropexy group. At median follow-up of 86 months, objective cure at overall compartments for all patients was 67.8%, and for subjective cure, this was 64.4%. There was no difference in the adjusted odds ratio for objective and subjective cure rates in both groups, but the hysterectomy group had a significantly lower mean total POPDI-6 score.
  
  
  CONCLUSIONS
  SSF plus AC and PC have a low reoperation rate despite a moderate success rate at 7-year follow-up. There was no difference in the adjusted objective, subjective success rates and sexual function between sacrospinous hysteropexy and hysterectomy. The hysterectomy group, however, had fewer bothersome prolapse symptoms.
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung/Taipei Medical Center, Keelung/Taipei, Taiwan.|Division of Urogynecology, Department of Obstetrics and Gynecology, Linko, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|Chang Gung University, School of Medicine, Taoyuan, Taiwan.
authors: Tsia-Shu
authors: TS
authors: Lo
authors: Division of Urogynecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Serdang Hospital, Selangor, Malaysia.
authors: Leng Boi
authors: LB
authors: Pue
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung/Taipei Medical Center, Keelung/Taipei, Taiwan.|Chang Gung University, School of Medicine, Taoyuan, Taiwan.
authors: Tai-Ho
authors: TH
authors: Hung
authors: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung/Taipei Medical Center, Keelung/Taipei, Taiwan.|Division of Urogynecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Pei-Ying
authors: PY
authors: Wu
authors: Division of Urogynecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Kuching General Hospital, Sarawak, Malaysia.
authors: Yiap Loong
authors: YL
authors: Tan
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects*; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000517:prevention & control; D013624:Taiwan / Q000453:epidemiology; D014621:Vagina / Q000601:surgery*
keywords: colporraphy; hysteropexy; long-term outcome; sacrospinous ligament fixation; vaginal hysterectomy