BENEFITS OF HYSTEROPEXY VERSUS HYSTERECTOMY
When patient suffers from uterine prolapse or collision dyspareunia (painful sex with deep thrusting) most surgeons will offer the patient a hysterectomy (removal of the uterus) instead of a less invasive and less traumatic hysteropexy or uterine suspension. Dr Miklos & Moore have been offering a laparosopic hysteropexy for almost 20 years with a success rate greater than 98%.
What is the benefit of keeping the uterus?
Women who choose to keep their uterus do so because they feel it is part of their body, orgasmic function or part of their femininity. Other benefits include: preservation of fertility, less chance of vaginal pain with intercourse due to removal of the uterus and scar tissue at the apex of the vagina, less chance of surgical complications, and a faster recovery from the surgery when compared to a hysterectomy. It is a woman’s choice to retain their own body parts however there are exceptions or reason why Drs Miklos & Moore would recommend not keeping one’s uterus.
When would it be recommenced to have a hysterectomy over a hysteropexy?
Drs Miklos & Moore are strong woman advocates who have been recommending uterine preservations i.e. hysteropexy for 20 years, however sometimes it is in the best interest of the woman to remove the uterus i.e. hysterectomy. These reasons include: 1) a history or more importantly a recent history of abnormal PAP smears indicative of a precancerous condition of the cervix 2) abnormal uterine bleeding 3) proliferative endometrium (aka thickened lining of the uterus) and this can be indicative of a precancerous condition of the uterus 4) central chronic pelvic pain i.e. the uterus is responsible for pain (excludes collision dyspareunia) and possibly 5) severe uterine prolapse.
Is it safer to perform a hysterectomy or do a hysteropexy?
Though considered a relatively safe operation the hysterectomy has a greater chance of many intra operative complications. The most common complications of a hysterectomy include: infections (9-13%), blood clots (1-12%), lower urinary tract injury (bladder and ureters) – 1-2 %, gastrointestinal injuries (bowel, colon, rectum) 0.1% – 1.0%, bleeding (150 mL – 570 mL), nerve injury (0.2-2.0%), and vaginal wound breakdown (0.4%). 1
Drs Miklos & Moore complication rate for a hysteropexy for each of the above are as follows: urinary tract infection rate (5-10%), wound infection rate (2%), gastrointestinal injury ( <1/500), lower urinary tract injury (<1/500), average blood loss (30 mL = 1 tablespoon), Nerve injury (<1/500) and vaginal wound breakdown (<1/500). It is obvious the hysteropexy is a safer surgical procedure than the hysterectomy.
Which surgery takes longer to perform?
When the surgeries are performed by Dr Miklos and Moore the hysteropexy is found to be a much more rapid surgery. Their average time for a hysteropexy is approximately 30 minutes and a hysterectomy is about 45 – 60 minutes. Though both surgeries are considered safe surgeries, longer surgeries tend to be associated with higher infection rates, more blood loss, greater chance of strokes, heart attacks and more pain.
Is the hysteropexy more painful than a hysterectomy?
It has been Dr Miklos & Moores observation that suspending the uterus ie hysteropexy causes dramatically less pain than the hysterectomy despite the incision on the abdomen are the same size. The pain is due to the vaginal manipulation involved with the hysterectomy as well as cutting the uterus away from the supporting structures and the vagina. Most patients getting a hysteropexy have a mild to moderate pain the day after surgery.
1 Clarke-Pearson DL, Geller EJ. Complications of hysterectomy Obstet Gynecol 2103 Mar;121(3):654-73. doi: 10.1097/AOG.0b013e3182841594.