Effect of Vaginal Mesh Hysteropexy vs Vaginal Hysterectomy With Uterosacral Ligament Suspension on Treatment Failure in Women With Uterovaginal Prolapse

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Abstract
Surgery for uterovaginal prolapse is common. In an analysis of a US database from 2007 to 2011, an estimated 13% of women underwent pelvic organ prolapse surgery by the age of 80 years.1 In a 2016 British Society of Urogynecology survey with a 42% response rate, 75% of 212 urogynecology surgeons considered vaginal hysterectomy the procedure of choice for women with uterovaginal prolapse.2 Uterine-sparing suspension techniques, known as hysteropexy, are increasing in usage, but in a US inpatient hospital database from 2002 to 2012, hysteropexy accounted for 5% of uterovaginal prolapse procedures and hysterectomies were performed 8 times more often.3 In a survey of 244 US women with an 89% response rate, 36% preferred uterine preservation, 20% preferred hysterectomy, and 44% were ambivalent assuming comparable outcomes at the time of uterovaginal prolapse repair.4 The broad range of age, goals, and expectations of women who seek prolapse surgical correction and the elective nature of treatment are ideally weighed in a shared decision-making process grounded in sound scientific evidence.

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