Sacrospinous hysteropexy: review and meta-analysis of outcomes
Jessica Amy Robertson
Received: 22 November 2016 / Accepted: 2 February 2017 / Published online: 3 March 2017
The International Urogynecological Association 2017
Introduction Sacrospinous hysteropexy is a uterine-preserving
procedure for treatment of apical prolapse. We present a literature
review evaluating the sacrospinous hysteropexy procedure and
its current place in the surgical management of pelvic organ
prolapse. Additionally, to assess the efficacy of the procedure,
we performed a meta-analysis of studies comparing sacrospinous
hysteropexy to vaginal hysterectomy and repair in terms of ana-
tomical outcomes, complications, and repeat surgery.
Methods Major literature databases including MEDLINE
(1946 to 2 April 2016), Cochrane Central Register of
Controlled Trials (CENTRAL; 2016, Issue 3), and Embase
(1947 to 2 April 2016) were searched for relevant studies.
We used Cochrane Collaboration’s Review Manager software
to perform meta-analysis of randomized controlled studies
and observational studies.
Results Vaginal sacrospinous hysteropexy was first performed
in 1989 and is similar in technique to sacrospinous colpopexy.
Two randomized controlled trials and four cohort studies (n =
651) were included in the meta-analysis. Apical failure rates after
sacrospinous hysteropexy versus vaginal hysterectomy were not
significantly different, although the trend favored vaginal hyster-
ectomy [odds ratio (OR) 2.08; 95% confidence interval (CI)
0.76–5.68]. Rates of repeat surgery for prolapse were not signif-
icantly different between the two groups (OR 0.99; 95% CI
0.41–2.37). The most significant disadvantage of uterine-
preservation prolapse surgery when compared with hysterecto-
my is the lack of prevention and diagnosis of uterine malignancy.
Conclusion Sacrospinous hysteropexy is a safe and effective
procedure for pelvic organ prolapse and has comparable out-
comes to vaginal hysterectomy with repair.
Keywords Apical prolapse
Va gina l h y s te r e ct o m y
Vaginal hysterectomy, with or without repair, is the most com-
mon procedure performed for apical prolapse. The underlying
etiology of apical prolapse is a weakness in the supports of the
uterus and upper vagina [1, 2]. There is a growing body of
evidence to suggest that uterine preserving procedures for
treatment of prolapse are effective and safe . Vaginal
sacrospinous hysteropexy is a relatively simple procedure
which can be carried out by the generalist gynecologist who
performs vaginal repairs. We present a literature review eval-
uating the current place of sacrospinous hysteropexy in the
surgical management of pelvic organ prolapse. Additionally,
to assess the efficacy of the procedure, we performed a meta-
analysis comparing sacrospinous hysteropexy with vaginal
hysterectomy and repair in terms of anatomical outcomes,
complications, and repeat surgery rates.
Post-hysterectomy vault prolapse prompted initial attempts to
anchor the vaginal apex to a fixed point in the pelvis, in the
1890s . In 1951, Amreich reported on his experience with
vaginal sacrotuberal fixation . In the 1950s, sacrospinous
colpopexy was popularized by two German gynecologists,
Sederl and Richter [6, 7].
* Kanapathippillai Sivanesan
Ipswich Hospital, QLD Health, University of Queensland,
Chelmsford Avenue, Ipswich, QLD 4305, Australia
Int Urogynecol J (2017) 28:1285–1294