Uterine-Preserving Surgery Viable Alternative to Hysterectomy for native-tissue prolapse repair: Study

A new study published in the American Journal of Obstetrics and Gynecology showed that uterine-preserving surgery was a viable alternative to Hysterectomy for native-tissue prolapse repair. The study reinforces the growing real-world evidence supporting uterine-preserving surgery as a safe, efficient, and effective option for native tissue prolapse repair. Therefore with many patients preferring to retain their uterus and consistent evidence backing this approach, it should be routinely offered as a standard care option alongside hysterectomy-based procedures for pelvic organ prolapse.

This research combined a practical, patient-centered, and autonomy-focused strategy by using a nonrandomized design in which patients choose their own surgical group. With the assistance of fellowship-trained urogynecologists, participants made their own decisions and were led by impartial, evidence-based talks when deciding between hysterectomy-based surgery and uterine-preserving surgery.

To mimic a randomized clinical trial, baseline disparities between surgery groups were balanced using inverse probability of treatment weighting based on high-dimensional propensity ratings. Nearly, 321 individuals with stage ≥2 uterine prolapse who wanted surgery were included in a prospective cohort trial between 2020 and 2022, and they were monitored for a year (retention >90%).

Hysteropexy or hysterectomy with vaginal vault suspension, with treatment of anterior and/or posterior prolapse if required, were the options available to patients seeking uterine-preserving pelvic organ prolapse surgery. The main result was a recurrence of anatomic prolapse within a year, which was defined as apical fall of at least 50% of the vaginal length.

Perioperative, functional, clinical, and healthcare outcomes assessed at six weeks and a year were secondary endpoints. Relative risks and adjusted mean differences were estimated using modified Poisson regression and inverse probability of treatment weighted linear regression, respectively. 

At one year, the adjusted relative risk was 0.35 because of the apical anatomic recurrence rates of 17.2% after hysterectomy and 7.5% with uterine preservation. In comparison to a hysterectomy, uterine-preserving surgery was linked to shorter hospital stays and surgical times, lower 24-hour opioid consumption, and fewer procedural problems.

Based on anatomic results, uterine-preserving surgery was linked to a decreased risk of composite recurrence when compared to hysterectomy up to one year. Functional and healthcare outcomes did not differ across surgery groups in a way that was clinically significant.

Overall, this work contributes empirical data to the expanding body of research that supports uterine-preserving surgery as a safe, effective, and efficient substitute for hysterectomy in the treatment of native tissue prolapse.

Source:

Brennand, E. A., Scime, N. V., Huang, B., Edwards, A. D., Kim-Fine, S., Hall, J., Birch, C., Robert, M., Carter Ramirez, A., & Calgary Women’s Pelvic Health Research Group. (2025). Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study. American Journal of Obstetrics and Gynecology, 232(5), 461.e1-461.e20. https://doi.org/10.1016/j.ajog.2024.10.021