The uterus debate in vaginal native tissue repair for pelvic organ prolapse: Hysteropexy versus hysterectomy – A systematic review and meta-analysis

Abstract

Introduction

Pelvic organ prolapse is a common condition with significant impact on women’s quality of life. Following restrictions on transvaginal mesh, native tissue repair has re-emerged as the mainstay of vaginal prolapse surgery. The role of hysterectomy in apical prolapse repair remains debated, with uterus-preserving techniques proposed as less invasive alternatives.

Methods

We conducted a systematic review and meta-analysis according to PRISMA guidelines (PROSPERO CRD420251132469). Studies comparing vaginal hysterectomy with sacrospinous or uterosacral hysteropexy in native tissue repair were included. Primary outcomes were apical recurrence, global anatomical success, subjective success, and reoperation rates. Secondary outcomes included operative time, blood loss, hospital stay, and major complications. Random-effects models were used for statistical pooling.

Results

Sixteen studies involving 2544 women (1364 hysterectomy, 1180 hysteropexy) were analyzed. Pooled results showed no significant difference between hysterectomy and hysteropexy for apical recurrence (OR 0.60, 95 % CI 0.30–1.19), global anatomical success (OR 1.33, 95 % CI 0.88–2.02), subjective success (OR 0.92, 95 % CI 0.63–1.34), or reoperation rates (OR 1.04, 95 % CI 0.56–1.96). Similarly, no difference was observed in major complications (Clavien-Dindo ≥ III). However, hysterectomy was associated with longer operative time (+29 min), greater blood loss (+80 mL), and longer hospital stay (+1.1 days.

Conclusions

In vaginal native tissue repair for pelvic organ prolapse, hysterectomy and hysteropexy provide comparable anatomical and functional outcomes, as well as similar safety and reintervention rates. Hysteropexy appears advantageous in reducing perioperative morbidity and resource use, supporting its role as an effective, uterus-preserving alternative to hysterectomy.