Uterine Preservation versus Hysterectomy During Sacrospinous Colpopexy for Uterovaginal Prolapse

Objective: To compare the effectiveness and safety of uterine preservation versus hysterectomy during SSC for uterovaginal prolapse. Methodology: Ninety female patients diagnosed with uterovaginal prolapse were enrolled in a prospective study conducted from March 2023 to February 2024 at Department of Gynecology, Ayub Teaching Hospital Abbottabad. Patients were randomly assigned to either uterine preservation or hysterectomy groups during SSC. Pre-operative assessments included pelvic examinations, imaging studies, and urodynamic evaluations. Surgical outcomes such as operative time, blood loss, complications, and anatomical success rates were recorded. Post-operatively, patients were followed up at regular intervals to assess subjective outcomes including symptoms relief, quality of life improvements, and sexual function. Results: Both uterine preservation and hysterectomy groups showed comparable anatomical success rates and symptom relief following SSC. Operative time was longer in the uterine preservation group (p = 0.028), while hospital stay was shorter in the hysterectomy group (p = 0.041). No significant differences were observed in intraoperative blood loss (p = 0.102), infection rates (p = 0.076), or prolapse recurrence (p = 0.194). However, reoperation rates were higher in the uterine preservation group (p = 0.012), whereas patient satisfaction was notably higher among those who opted for uterine preservation (p = 0.001). Conclusion: Uterine preservation during sacrospinous colpopexy appears to be a viable option for treating uterovaginal prolapse, offering comparable outcomes to hysterectomy in terms of anatomical support, symptom relief, and patient satisfaction. This study suggests that the decision between uterine preservation and hysterectomy during SSC should be individualized based on patient preferences, anatomical considerations, and the presence of co-existing conditions.