The effectiveness of surgical procedures to prevent post-hysterectomy pelvic organ prolapse: a systematic review of the literature

Int Urogynecol J. 2021 Apr;32(4):775-783. doi: 10.1007/s00192-020-04572-2. Epub 2020 Nov 5.

Abstract

Introduction and hypothesis: Hysterectomy is one of the most commonly performed gynecological surgical procedures. One of the long-term risks associated with hysterectomy is the occurrence of pelvic organ prolapse (POP). To prevent post-hysterectomy POP, several suspension procedures are routinely performed at the time of hysterectomy. We performed a systematic review of published data in order to define the most effective surgical procedures for the prevention of post-hysterectomy POP.

Methods: We performed a systematic review of the literature by searching PubMed, the Cochrane Library, EMBASE, Ovid MEDLINE, and clinicaltrials.gov up to 24 May 2020. The search strategy included the keywords hysterectomy, post-hysterectomy, prolapse, colposuspension, culdoplasty, McCall, and combinations thereof. The inclusion criterion was a surgical procedure at the time of hysterectomy to prevent de novo POP. The outcome was incidence of post-hysterectomy POP.

Results: Six out of 553 retrieved studies met the methodological criteria for complete analysis. In this review, 719 women aged over 18 years were included. Only 2 studies were designed as prospective trials; however, only 1 compared women undergoing a procedure at the time of hysterectomy with controls. The prevalence of post-hysterectomy prolapse varied from 0% to 39%.

Conclusion: A systematic review of published literature suggests that performing variations of McCall culdoplasty at the time of hysterectomy might be the most effective prophylactic surgical procedure for preventing post-hysterectomy pelvic organ prolapse.

Keywords: Hysterectomy; Post-hysterectomy pelvic organ prolapse.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Female
  • Gynecologic Surgical Procedures / adverse effects
  • Humans
  • Hysterectomy / adverse effects
  • Middle Aged
  • Pelvic Organ Prolapse* / etiology
  • Pelvic Organ Prolapse* / prevention & control
  • Pelvic Organ Prolapse* / surgery
  • Prospective Studies
  • Treatment Outcome