Hysteropexy Versus Hysterectomy-Based Prolapse Repairs In The Surgical Treatment Of Pelvic Organ Prolapse:A Meta-analysis

Objective:To compare the effect of pelvic floor reconstruction for pelvic organ prolapse between hysteropexy and hysterectomy-based prolapse repairs.Method:By searching the databases,which include Pubmed,MEDLINE,Cochrane library,EMbase,Ovid,Web of Science,CBM,CKNI,VPCS and Wan Fang Data,we collected the literature on hysteropexy and hysterectomy-based prolapse repairs in the surgical treatment of pelvic organ prolapse,which published both at home and abroad between 2001 and 2018.The literature was screened according to the special inclusion and exclusion criteria.Then data extraction and quality evaluation were performed.A Meta analysis was performed by using Review Manager5.3 software.Finally,we compared duration of surgery,blood loss,length of hospital stay,hospital expenses,postoperative dysuria,postoperative urinary incontinence,postoperative quality of sexual life,postoperative vaginal length and repeat surgery between two surgical approaches.Result:Totally 14 studies were recruited,and 5 were RCTs and 9 were observational studies.A total of 1654 participants were included into the study,including 770 with hysteropexy and 884 with hysterectomy.The results of meta-analysis showed that,the hysteropexy approach had lower operation time(MD-24.28 minutes,95%confidence interval[CI],-32.26 to-16.29 minutes),estimated blood loss(MD-48.65 mL,95%Cl,-70.56 to-26.74 mL)hospital stay(MD-0.33 days,95%Cl,-0.54 to-0.13 days)than the hysterectomy approach.The hysteropexy approach did not have longer vaginal length(MD 0.56 cm,95%CI,-0.19 to 1.31 cm)than the hysterectomy approach,and the influence of the sexual life(OR1.18,95%CI,0.39 to 3.59)was similar.The total cost in hospital(MD-1598.54 RMB,95%CI,-3346.35 to 149.27 RMB),postoperative concurrent urination disorder(OR0.92,95%CI,0.52 to 1.61),postoperative urinary incontinence(RR1.05,95%CI,0.65 to 1.69)and repeat surgery for recurrence of prolapse(OR1.26,95%CI,0.84 to 1.87)was similar in both approaches.Conclusion:Compared with hysterectomy-based prolapse repairs,hysteropexy does not increase the common postoperative complications in the surgery of pelvic organ prolapse.For patients without high-risk tumor factors,with younger age or active sex life,as well as somebody who cannot tolerate major surgery,hysteropexy may be a better choice.