Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: An evolving concept

Objective: The purpose of this study was to evaluate the efficacy of the performance of sacrospinous cervicocolpopexy with uterine conservation in the treatment of uterovaginal prolapse in women over the age of 60 years. Study Design: This was a nonrandomized prospective controlled study. Between February 1996 and January 2001, 109 women above the age of 60 years with a complaint of symptomatic uterovaginal prolapse were treated with either sacrospinous cervicocolpopexy with uterine conservation or vaginal hysterectomy concomitant with sacrospinous colpopexy. Patients were reviewed at 6 weeks and 6 and 12 months after operation and then yearly thereafter. Preoperative patient characteristics, operative, and postoperative events and follow-up results were recorded. Results: During the study period, 61 patients (56%) underwent sacrospinous cervicocolpopexy with uterine conservation (group A), whereas 48 patients (44%) had vaginal hysterectomy performed concomitantly with sacrospinous colpopexy (group B). The mean age for the two groups was comparable (70.1 ± 6 years vs 69.4 ± 4.6 years, respectively; P = .8). Group A had significantly less blood loss (P< .01), shorter operating time (P< .01), and fewer complications after surgery (P = .01) compared with group B. After a mean follow-up period of 33 and 34 months, respectively, the two groups had comparable success rates with regard to uterine and upper vaginal support (93.5% and 95.9%, respectively; P = .6). Recurrent cystocoele developed in 11.4% and 10.4% of groups A and B, respectively (P = .9). Within the follow-up period, 3 patients (5%) in group A and 2 patients (4.2%) in group B underwent repeat operation for recurrent uterovaginal or vault prolapse. Conclusion: Sacrospinous cervicocolpopexy with uterine conservation is a safe and effective surgical option that could benefit elderly patients with uterovaginal prolapse. It avoids the potential morbidity of vaginal hysterectomy and is associated with a high success rate. (Am J Obstet Gynecol 2003;188:645-50.)