Is Native Tissue Hysteropexy Better Than Hysterectomy?

Pelvic organ prolapse affects millions of women worldwide, and clinicians must frequently choose between uterine-preserving and hysterectomy-based repairs. Consequently, native tissue hysteropexy has emerged as a popular alternative to traditional hysterectomy with apical suspension. However, clinical data comparing their long-term outcomes remain limited.

Key Findings for Native Tissue Hysteropexy

A recent retrospective cohort study evaluated 2,499 women undergoing hysterectomy and 876 women undergoing hysteropexy. Both cohorts received concomitant apical suspension, utilizing either uterosacral ligament suspension or sacrospinous ligament fixation. Specifically, researchers tracked long-term retreatment outcomes over a median follow-up of approximately nine years. The results showed that native tissue hysteropexy increased the risk of prolapse reoperation compared with hysterectomy. Specifically, the reoperation rate was 11.1% in the hysteropexy group compared to 6.5% in the hysterectomy group. Furthermore, the overall prolapse retreatment rate, which included reoperation or pessary use, was also higher for hysteropexy. In contrast, only 2.9% of women in the hysteropexy group required a subsequent hysterectomy during the follow-up period.

Short-Term Complications and Clinical Considerations

While long-term retreatment rates favor hysterectomy, short-term outcomes show a different trend. For instance, within 30 days of surgery, native tissue hysteropexy demonstrated fewer complications. Specifically, hysteropexy led to lower rates of urinary retention and urinary tract infections. These short-term benefits can be crucial for elderly patients or those with multiple comorbidities. Therefore, gynecologists must carefully weigh the immediate recovery advantages against the potential risk of long-term failure. Patients highly value uterine-preserving options; consequently, shared decision-making is essential in clinical practice.

Frequently Asked Questions

Q1: Does native tissue hysteropexy carry a higher risk of prolapse recurrence than hysterectomy?

Specifically, long-term data show that native tissue hysteropexy carries a higher risk of both reoperation and overall prolapse retreatment.

Q2: What are the main short-term benefits of choosing native tissue hysteropexy?

For example, patients undergoing hysteropexy experience lower rates of urinary retention and urinary tract infections. Additionally, this approach avoids removal of the uterus.

References

1. Akavian I et al. Long-Term Outcomes After Native Tissue Hysteropexy Compared With Hysterectomy for Treatment of Pelvic Organ Prolapse. Obstet Gynecol. 2026 Jul 09. doi: 10.1097/AOG.0000000000006371. PMID: 42424621.
2. Lange S, Carlin G, Zängle R, et al. Subjective Long-Term Outcomes After Vaginal Native Tissue Hysteropexy: Cohort Study. Urogynecology (Phila). 2024 Aug 1;30(8):714-720. doi: 10.1097/SPV.0000000000001449.
3. Schiavi MC, et al. Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study. Am J Obstet Gynecol. 2024.