What is the role of hysterectomy in pelvic organ prolapse treatment?

Abstract

Pelvic organ prolapse (POP) is a condition with an increasing incidence rate, affecting more than 40% of women over 50 years old. There are three levels of pelvic floor support, described by Delancey. The individual impact of each of them leads to the appearance of prolapse in a certain compartment (anterior, posterior or apical), the therapeutic conduct being individualized in each situation. In the case of symptomatic apical POP or after the failure of conservative treatment, the treatment of choice is the surgical one, with hysterectomy in the first place, followed by pelvic reconstruction procedures with the preservation of the uterus. These procedures can be performed through a vaginal approach, if access allows, or transabdominally, classically or through laparoscopy. Additionally, there are numerous procedures for ligamentous suspension of the remaining vaginal apex, thus having the freedom to combine different approaches with different procedures, with the aim of a lasting result. Regarding the recurrence rate, comparing vaginal hysterectomy followed by ligament fixation with native tissue with hysteropreservation interventions, there is a significant decrease in POP recurrence after hysterectomy. However, compared in general, no long-term difference in pelvic organ prolapse recurrence is observed. Moreover, being an invasive procedure that requires extensive dissection of the tissues, there is a longer duration of the operating time, with an above average hemorrhage in case of hysterectomy, the patients having a longer duration of hospitalization. The decision regarding the chosen surgical option must be taken together with the patient, after presenting the advantages and disadvantages of each method, as well as the evaluation of the biological state and the risks of a prolonged surgical intervention. An important factor is the existence of some gynecological background (metrorrhagia, endometrial polyps, uterine fibroids), an aspect that pleads for the excision of the uterus.