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A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function

  1. Jan-Paul W.R. Roovers1,*,
  2. C. Huub van der Vaart1,
  3. Johanna G. van der Bom2,
  4. Jules H. Schagen van Leeuwen3,
  5. Piet C. Scholten4,
  6. A. Peter M. Heintz1

Article first published online: 15 DEC 2003

DOI: 10.1111/j.1471-0528.2004.00001.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 111, Issue 1, pages 50–56, January 2004

Additional Information

How to Cite

Roovers, J.-P. W.R., van der Vaart, C. H., van der Bom, J. G., Schagen van Leeuwen, J. H., Scholten, P. C. and Heintz, A. P. M. (2004), A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. BJOG: An International Journal of Obstetrics & Gynaecology, 111: 50–56. doi: 10.1111/j.1471-0528.2004.00001.x

Author Information

  1. 1

    Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands

  2. 2

    Julius Center for Patient Oriented Research, University Medical Center, Utrecht, The Netherlands

  3. 3

    Department of Obstetrics and Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands

  4. 4

    Department of Obstetrics and Gynaecology, Diakonessenhuis, Utrecht, The Netherlands

* *: Dr J. P. W. R. Roovers, Department of Obstetrics and Gynaecology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.

Publication History

  1. Issue published online: 15 DEC 2003
  2. Article first published online: 15 DEC 2003

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Objective  To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function.

Design  Randomised trial.

Setting  Three teaching hospitals in The Netherlands.

Population  Eighty-two patients undergoing surgical correction of uterine prolapse stages II–IV.

Methods  Participating patients completed the urogenital distress inventory (UDI), before and at six weeks, six months and one year after surgery, to measure discomfort of prolapse and micturition symptoms. Domain scores of the UDI (ranging from 0 to 100, higher scores indicating more discomfort) were compared between groups at all time points. Findings at pelvic examination, number of doctor visits within the first year after surgery because of pelvic floor symptoms and performed or planned surgery of recurrent genital prolapse were also compared.

Main outcome measure  Domain scores of the UDI at one year after surgery.

Results  At one year after surgery, scores on the discomfort/pain domain (mean difference 7.1, 95% confidence interval [CI] 1.1–13.2), overactive bladder domain (mean difference 8.7, 95% CI 0.5–16.9) and obstructive micturition domain (mean difference 10.3, 95% CI 0.6–20.1) of the UDI were significantly higher in the abdominal group than in the vaginal group. Findings at pelvic examination were similar in both groups. Doctor visits because of pelvic floor symptoms were more frequent in the abdominal group than in the vaginal group. Re-operation was performed or planned in 9 of the 41 patients who underwent abdominal surgery and in 1 of the 41 patients who underwent vaginal surgery (odds ratio [OR] = 11.2, 95% CI 1.4–90.0).

Conclusions  Our findings suggest that vaginal hysterectomy with anterior and/or posterior colporraphy is preferable to abdominal sacro-colpopexy with preservation of the uterus as surgical correction in patients with uterine prolapse stages II–IV.

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