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Federación Mexicana de Ginecología y Obstetricia, A.C.

2025, Number 8

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Ginecol Obstet Mex 2025; 93 (8)

Does the hysterectomy approach route influence the incidence of vault prolapse?

López RCC, de los Ríos PJF, Pandales PH, Correa RS, Vargas EC, Cardona AJ, Vásquez TEM, Rojas GDF, Salazar GA, Correa OJL

Language: Spanish
References: 23
Page: 305-313
PDF size: 228.63 Kb.


ABSTRACT

Objective: To compare the five-year incidence of post-hysterectomy vault prolapse according to the access route (vaginal, abdominal, or laparoscopic) in patients over 18 years of age, indicated for benign disease other than uterine prolapse. The secondary objective was to evaluate the incidence of anterior and posterior compartment prolapse in the different access routes and the frequency of associated symptoms.
Materials and Methods: This was an ambispective cohort study with five-year follow-up of patients undergoing hysterectomy treated at Clínica del Prado and Clínica Medellín, Colombia, between 2010 and 2015, for reasons other than genital prolapse. Anterior prolapse was defined as an outcome, established by physical examination performed by gynecologists and measurement of the POP-Q (pelvic organ prolapse). Patient characteristics were described according to access route, estimating frequencies, percentages for categorical variables, and medians and quartiles for quantitative variables.
Results: Of 345 patients evaluated, the cumulative incidence of vault prolapse was low and showed no significant differences between vaginal (0.97%), abdominal (0%), and laparoscopic (0.81%) approaches (p = 0.884). No statistically significant differences were found in the incidence of overall or symptomatic prolapse, or in the impact on sexual function or quality of life. Individual factors associated with risk were identified: advanced age, multiparity, smoking, and chronic obstructive pulmonary disease.
Conclusion: Surgical access does not significantly influence the five-year risk of vault prolapse in patients with no history of prolapse. The initial surgical indication and personal factors appear to be more relevant in the development of prolapse. These findings support individualization of the surgical approach and reinforce the need for preoperative counseling.


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