Hysteropreservation versus hysterectomy in uterine prolapse surgery: a systematic review and meta-analysis

• Published in: International Urogynecology Journal Vol. 33; no. 7; pp. 1917 - 1925
• Main Authors: He, Li, Feng, Dan, Zha, Xi, Liao, Xiao-Yan, Gong, Zhao-Lin, Gu, Ding-Qian, Lin, Yong-Hong, Huang, Lu
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2022; Springer Nature B.V
• Subjects: Clinical trials; Confidence intervals; Constipation; Gynecology; Hysterectomy; Medicine; Medicine & Public Health; Meta-analysis; Original Article; Pelvic organ prolapse; Surgery; Systematic review; Urology; Uterus; Vagina; Systematic review; Hysteropexy; Hysterectomy; Uterine prolapse; Surgery
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-021-04913-9

Introduction and hypothesis
Hysteropreservation and hysterectomy for uterine prolapse have been compared in several randomized controlled trials (RCTs), as the best treatment has not been definitively determined. This study aimed to summarize the available evidence in RCTs of hysteropreservation versus hysterectomy.
Methods
We performed electronic searches in the PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure databases for eligible RCTs from inception to June 2020. The relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were calculated for categorical and continuous variables using random-effects models.
Results
Twelve RCTs involving 1177 patients were selected for meta-analysis. There were no significant differences between hysteropreservation and hysterectomy for the incidences of recurrence (RR, 0.55; 95% CI, 0.26–1.19;
P
 = 0.130) and reoperation (RR, 1.15; 95% CI, 0.56–2.37;
P
 = 0.705). Moreover, neither hysteropreservation nor hysterectomy had any significant effect on the risk of constipation (RR, 0.72; 95% CI, 0.15–3.46;
P
 = 0.681), voiding dysfunction (RR, 0.99; 95% CI, 0.54–1.84;
P
 = 0.981), intraoperative bleeding (RR, 0.35; 95% CI, 0.05–2.26;
P
 = 0.271), upper leg dullness (RR, 0.70; 95% CI, 0.15–3.17;
P
 = 0.643), dyspareunia (RR, 1.47; 95% CI, 0.69–3.13;
P
 = 0.317), and wound infection (RR, 1.38; 95% CI, 0.24–7.80;
P
 = 0.714). Furthermore, hysteropreservation was associated with less intraoperative blood loss (WMD, −25.68; 95% CI, −44.39 to −6.96;
P
 = 0.007), shorter duration of surgery (WMD, −11.30; 95% CI, −19.04 to −3.55;
P
 = 0.004), and shorter duration of hospitalization (WMD, −0.63; 95% CI, −1.10 to −0.16;
P
 = 0.009) compared with hysterectomy.
Conclusion
This study found that both hysteropreservation and hysterectomy have similar effects on recurrence and reoperation rates, while hysteropreservation was superior to hysterectomy in reducing intraoperative blood loss and shortening the duration of surgery and hospitalization.