Hysteropexy Versus Hysterectomy for Uterine Prolapse: Long-Term Prolapse Recurrence and Sexual Function

Abstract

Introduction: Uterine-preserving prolapse surgery (hysteropexy) is an alternative to hysterectomy for uterine prolapse. Comparative long-term outcomes on recurrence and sexual function guide surgical choice.
Methods: Systematic review of randomized controlled trials and prospective cohort studies with minimum 24 months follow-up. Primary outcome: anatomic recurrence (any compartment). Secondary: prolapse symptoms and sexual function (PISQ-12).
Results: Nine studies (n=2,100 women) were analyzed. Recurrence rate at 3 years was 24% for hysteropexy versus 18% for hysterectomy (risk ratio 1.33). However, reoperation for prolapse was similar (9% vs. 8%). Sexual function scores favored hysteropexy slightly (mean difference 3.2 points). Operative time and blood loss were lower with hysteropexy.
Discussion: Hysteropexy has higher anatomic recurrence but similar need for reoperation, suggesting recurrences are often asymptomatic. Preservation of the uterus may improve body image and sexual function.
Conclusions: Hysteropexy is a reasonable alternative to hysterectomy for uterine prolapse, with comparable reoperation rates and better sexual function, albeit higher anatomic recurrence. Shared decision-making should include patient priorities.