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Uterovaginal Prolapse: Hysteropexy vs. Hysterectomy Introduction. Marie Fidela R. Paraiso, M.D. Head, Division of Urogynecology Professor of Surgery Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, OH.

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uterovaginal prolapse hysteropexy vs hysterectomy introduction

Uterovaginal Prolapse: Hysteropexy vs. HysterectomyIntroduction

Marie Fidela R. Paraiso, M.D.

Head, Division of Urogynecology

Professor of Surgery

Cleveland Clinic Lerner College of Medicine at

Case Western Reserve University

Cleveland, OH

whether or not to remove the normal uterus during pop surgery is controversial
Concurrent hysterectomy potentially adds to the morbidity, both in the short and long term

Increased OR time

Increased bleeding

Increased complexity

Evidence to implicate concurrent hysterectomy as a risk factor for subsequent mesh erosion [1,2,3]

Culligan PJ et al. Am J Obstet Gynecol (2002) 187: 1473-80; discussion 81-2.

Wu JM, et al. (2006) Am J Obstet Gynecol 194: 1418-22.

Brizzolara S, et al.(2003) Obstet Gynecol 102: 306-10.

Whether or not to remove the normal uterus during POP surgery is controversial.
care trial ancillary study on risk factors for mesh erosion
CARE TrialAncillary study on Risk Factors for Mesh Erosion

Demographic variables

Current smoking

5/20 (25%) erosion

18/302 (6%) no erosion

OR = 5.2 (CI 1.7,16.0)

No other differences

Surgical variables

Concurrent hysterectomy

12/20 (60%) erosion

71/302 (24%) no erosion

OR = 4.9 (CI 1.9,12.4)

No differences in:

Culdoplasty

Mesh configuration

Cundiff GW, et al. Am J Obstet Gynecol. 2008 Dec;199(6):688.e1-5. Epub 2008 Oct 31.

whether or not to remove the normal uterus during pop surgery is controversial1
Uterine preservation potentially compromises the efficacy of the repair

Future uterine pathology may necessitate future surgery

Uterine bleeding

Difficult hysterectomy

Whether or not to remove the normal uterus during POP surgery is controversial.
slide5
Comparison of Abdominal sacral hysteropexy to abdominal sacral colpopexy with hysterectomy: A Pilot Study.

Cvach K, et al.. International Continence Society Annual Scientific Meeting, Toronto, Canada, August 24, 2010.

debate specifics
Debate Specifics
  • Affirmative Team:
    • Dr. Jerry Blaivas
  • Negative Team:
    • Dr. Mickey Karram
  • Moderator:
    • Dr. Marie Paraiso
  • Judges:
    • Captive Audience
  • Style: Parliamentary (Modified)
resolution
Resolution

" In counseling a 42 y/o woman with stage III prolapse that includes loss of support of the uterus and associated symptoms of protrusion, but no other uterine pathology, the discussion of surgical management should include concurrent hysterectomy"