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Update in fertility-sparing native-tissue procedures for pelvic organ prolapse

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Abstract

Uterine-sparing prolapse surgery has been gaining back popularity with clinicians and patients. Although both prosthetic and native-tissue surgery procedures are described, the latter is progressively regaining a central role in pelvic reconstructive surgery, owing to a lack of mesh-related complications. Available native-tissue procedures have different advantages and pitfalls, as well as different evidence profiles. Most of them offer anatomical and subjective outcomes comparable with those of hysterectomy-based procedures. Moreover, native-tissue procedures in young women desiring childbearing allow to avoid synthetic material implantation, which may lead to potentially serious complications during pregnancy. As a consequence, we do think that offering a reconstructive native-tissue procedure for uterine preservation (with the exception of the Manchester procedure) is the safest option in women wishing for pregnancy. Sacrospinous ligament hysteropexy and high uterosacral ligament hysteropexy may be considered first-line options in consideration of the higher level of evidence and lack of adverse obstetrical outcomes.

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Author information

Authors and Affiliations

  1. San Paolo University Hospital, Milan, Italy

    Stefano Manodoro

  2. EOC-Beata Vergine Hospital, Mendrisio, Switzerland

    Andrea Braga & Giorgio Caccia

  3. Milano Bicocca University, Monza, Italy

    Marta Barba

  4. University of Insubria, Varese, Italy

    Maurizio Serati

  5. San Gerardo University Hospital, Via Pergolesi 33, 20900, Monza, Italy

    Matteo Frigerio

Authors
  1. Stefano Manodoro
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  2. Andrea Braga
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  3. Marta Barba
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  4. Giorgio Caccia
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  5. Maurizio Serati
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  6. Matteo Frigerio
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Contributions

S. Manodoro: protocol/project development, manuscript writing; A. Braga: protocol/project development, manuscript writing; M. Barba: protocol/project development, manuscript writing; G. Caccia: protocol/project development, manuscript writing; M. Serati: protocol/project development, manuscript writing; M. Frigerio: protocol/project development, manuscript writing.

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Correspondence to Matteo Frigerio.

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Manodoro, S., Braga, A., Barba, M. et al. Update in fertility-sparing native-tissue procedures for pelvic organ prolapse. Int Urogynecol J 31, 2225–2231 (2020). https://doi.org/10.1007/s00192-020-04474-3

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  • DOI: https://doi.org/10.1007/s00192-020-04474-3

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