Hysteropexy tied to greater retreatment risk than hysterectomy for POP | Image Credit: © H_Ko – © H_Ko – stock.adobe.com.

Investigators of a study published in the American Journal of Obstetrics & Gynecology have found a slightly increased surgical retreatment risk in patients receiving a hysteropexy for prolapse vs receiving a hysterectomy during native-tissue prolapse surgery.

Nearly 3% of US women experience pelvic organ prolapse, which is traditionally treated through hysterectomy. Hysteropexy has been considered as an alternative treatment method, with some studies highlighting potential decreases in surgical morbidity, operative time, and other outcomes.

“Current evidence remains mixed, and there is a lack of long-term data,” wrote investigators. “Existing retrospective studies are limited to less than 3 years of follow-up. Population database studies are limited to cohorts prior to 2012 or did not specifically include prolapse surgeries with apical suspension.”

Assessing pelvic organ prolapse treatment

The retrospective cohort study was conducted to evaluate surgical retreatment rates between hysterectomy and uterine preservation for pelvic organ prolapse following native-tissue apical prolapse surgery. Data from 2011 to 2021 was obtained from the Medicare 5% Limited Data Set.

Participants included women aged at least 65 years receiving native-tissue pelvic organ prolapse surgery with apical suspension based on Current Procedural Terminology (CPT) codes 57,282, 57,283, and 58,410. Exclusion criteria included concurrent mesh placement, obliterative procedures, and laparoscopic supracervical or open hysterectomy.

Pelvic organ prolapse was determined by International Classification of Diseases 9 or 10 codes, with concurrent hysterectomy based on CPT codes. Participants were classified as having a concurrent hysterectomy during native-tissue pelvic organ prolapse surgery or as having uterine preservation through hysteropexy.

Surgical retreatment for pelvic organ prolapse based on CPT codes was reported as the primary outcome, while secondary outcomes included any additional surgical treatment. Follow-up occurred until outcomes of interest, loss to follow-up, or death.

Surgical retreatment rates

There were 2341 participants included in the final analysis, 584 of whom underwent hysteropexy and 1757 underwent hysterectomy. Mean ages in these groups were 73.4 vs 71.8 years, respectively, and hypertension rates were 74.1% vs 68.8%, respectively.

A higher disease burden was reported in hysteropexy patients with a mean Charlson comorbidity index score of 1.6 vs 1.3 in hysterectomy patients. Follow-up occurred for a mean of 1445 and 1600 days, respectively.

During a 5-year follow-up period, repeat prolapse surgery was reported in 2.9% of the hysteropexy group and 2.3% of the hysterectomy group, indicating no significant difference. Unadjusted prolapse retreatment rates were 9.1% and 6.7%, respectively.

The risk of surgical retreatment significantly increased among patients receiving hysteropexy vs hysterectomy when adjusting for covariates, with an adjusted hazard ratio of 1.52. However, mortality risks did not significantly differ between groups.

Subsequent procedures and composite outcomes

Subsequent hysterectomy within 5 years of the index surgery was reported in 3.4% of patients receiving hysteropexy. Uterine or cervical-related procedures during this period occurred in 0.5% of the overall study population.

The hysteropexy group had a composite rate of surgical retreatment of 9.7%, vs 7% in the hysterectomy group. Overall, these results indicated significantly reduced future prolapse repair risk from hysterectomy over hysteropexy in Medicare patients.

“However, the absolute risk difference is small,” wrote investigators. “The decision to remove or retain the uterus at the time of prolapse surgery is complex with considerations of future risk of prolapse retreatment, potential development of uterine or cervical pathologies, and patients’ values.”

References

Chang OH, Ford C, Wu JM, Cadish LA, Jelovsek EJ. Surgical retreatment after native-tissue apical prolapse surgery with hysterectomy vs hysteropexy. Am J Obstet Gynecol. 2025;233:176.e1-6. doi:10.1016/j.ajog.2025.03.003Detollenaere RJ, den Boon J, Stekelenburg J, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717. doi:10.1136/bmj.h3717