title: The Impact of Sacrospinous Hysteropexy and Vaginal Hysterectomy With Suspension of the Uterosacral Ligaments on Sexual Function in Women With Uterine Prolapse: A Secondary Analysis of a Randomized Comparative Study.
abstract: BACKGROUND
  Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic.
  
  
  OBJECTIVE
  The aim of this secondary analysis was to evaluate and compare sexual function after sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse.
  
  
  METHODS
  This is a secondary analysis of the SAVE U trial data, a multicenter trial in 4 nonuniversity hospitals in the Netherlands comparing sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in primary surgery of uterine prolapse stage II or higher. Primary outcome of the original study was recurrent prolapse stage II or higher of the uterus or vaginal vault (apical compartment) evaluated by POP-Q examination in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months follow-up. Secondary outcomes were overall anatomical recurrences, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning. Data from patients who had completed the POP/urinary incontinence sexual questionnaire (PISQ-12) at baseline and 24 months after surgery were used in the present trial. Total, subscale, and individual question analyses were performed. The SAVE U trial is registered in the Dutch trial registry, number NTR1866.
  
  
  METHODS
  Differences and changes in sexual function 24 months after surgery, measured by the PISQ-12 questionnaire.
  
  
  RESULTS
  Between November 2009 and March 2012, 208 women were randomized between sacrospinous hysteropexy (n = 103) and vaginal hysterectomy with suspension of the uterosacral ligaments (n = 105). Of these, 99 women completed questionnaires at baseline and after 24 months follow-up and were included in the present study. During a follow-up period of 24 months, no significant differences in total PISQ-12 scores were observed between the groups. After both interventions the item "avoidance of intercourse due to prolapse" significantly improved, as did the physical subscale of the PISQ-12 questionnaire.
  
  
  CONCLUSIONS
  There was no statistically significant difference in overall sexual functioning (total PISQ-12 scores) between uterus-preserving sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments after a follow-up period of 24 months.
authors.affiliation: Department of Obstetrics and Gynecology, Isala, The Netherlands; Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: r.j.detollenaere@isala.nl.
authors.forename: Renée J
authors.initials: RJ
authors.lastname: Detollenaere
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Ilse A M
authors.initials: IA
authors.lastname: Kreuwel
authors.affiliation: Department of Obstetrics and Gynecology, Isala, The Netherlands.
authors.forename: Jeroen R
authors.initials: JR
authors.lastname: Dijkstra
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
authors.affiliation: Department of Obstetrics and Gynecology, Isala, The Netherlands.
authors.forename: Hugo W F
authors.initials: HW
authors.lastname: van Eijndhoven
mesh_terms: D000328:Adult; D003075:Coitus / Q000502:physiology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011184:Postoperative Period; D012404:Round Ligament of Uterus / Q000601:surgery*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000601:surgery; D014596:Uterine Prolapse / Q000453:epidemiology / Q000601:surgery*; D016387:Women's Health
keywords: Hysterectomy; Hysteropexy; PISQ-12; Sexual function; Uterus Preservation