Comparison of concomitant hysterectomy and uterine preservation for pelvic floor reconstruction using transvaginal mesh in the treatment of POP: a systematic review and meta-analysis.

Abstract

Objectives: This study aimed to summarize the evidence available in the published literature on concomitant hysterectomy versus uterine preservation in the treatment of pelvic organ prolapse (POP) and to clarify whether uterine removal should be performed during pelvic floor reconstructive surgery using transvaginal mesh (TVM).

Methods: The literature search strategy was specifically designed to identify articles investigating the comparison of concomitant hysterectomy and uterine preservation in pelvic floor reconstruction using TVM. The database search spanned from their inception until March 2024. The literature selection and data collection processes were guided by predetermined inclusion and exclusion criteria. The included studies were independently evaluated by two reviewers, and a meta-analysis was conducted utilizing RevMan 5.4.

Results: Eleven retrospective studies involving 1341 patients were selected for meta-analysis. The results showed no statistically significant differences in the objective cure rate or the risk of recurrence between concomitant hysterectomy and uterine preservation. Compared to uterine preservation, concomitant hysterectomy surgery was associated with extended operative duration (MD 31.59, 95% CI 19.49 - 43.68, p < 0.00001), longer hospital stay (MD 1.29, 95% CI 0.67 - 1.92, p < 0.0001), increased intraoperative blood loss (MD 62.52, 95% CI 30.18 - 94.86, p = 0.0002), reduced PISQ-12 scores (MD -5.99, 95% CI -9.70 to -2.28, p = 0.002), decreased postoperative total vaginal length (MD -0.66, 95% CI -1.14 to -0.18, p = 0.007), and higher risk of mesh exposure (RR 1.95, 95% CI 1.18-3.23, p = 0.009).

Conclusions: Uterine sparing surgery using TVM compared to concomitant hysterectomy surgery using TVM showed equally effective in the treatment of POP at short and medium term follow-up. But uterine preservation could reduce intraoperative blood loss, operative duration, and duration of hospitalization. In addition, uterine sparing surgery is beneficial for decreasing the risk of mesh exposure, increasing the vaginal length and improving sexual satisfaction.