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Vaginal Hysterectomy and Pelvic Organ Prolapse: History and Recent Developments

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Abstract

Introduction and hypothesis

Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable.

Methods

Literature review to provide an overview of current evidence and experts’ opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use.

Results

Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery.

Conclusions

Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care.

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Acknowledgements

The authors would like to thank superviseme LTD—medical writing services (http://www.superviseme.eu) for their help with the medical writing and editing of the manuscript. The authors would like to thank Cyrille Martinet from Atelier 55, medical illustrator (cyrille.atelier55@gmail.com) for creating the figures. The authors also thank Elsevier-Masson Editors for giving their permission to reproduce the drawings, from the book "Vaginal Surgery", by Michel Cosson, Denis Querleu, and Daniel Dargent, first edition, 2004, Paris.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Caremeau University Hospital, Nimes, France

    Renaud de Tayrac

  2. Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France

    Michel Cosson

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  1. Renaud de Tayrac
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  2. Michel Cosson
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R.D.T. and M.C. both participated in the conception, writing, and editing.

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Correspondence to Renaud de Tayrac.

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de Tayrac, R., Cosson, M. Vaginal Hysterectomy and Pelvic Organ Prolapse: History and Recent Developments. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05783-7

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