TOPLINE

Hysteropexy for pelvic organ prolapse was associated with an increased risk for reoperation and overall retreatment compared with hysterectomy with apical suspension.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from the TriNetX US Collaborative Network to compare long-term outcomes with hysterectomy vs hysteropexy after native tissue apical prolapse repair was performed.
• A total of 24,662 women with pelvic organ prolapse who underwent native tissue apical repair between 2005 and 2025; of these women, 17,573 underwent vaginal or laparoscopic-assisted hysterectomy and 7089 underwent hysteropexy without hysterectomy, both with concomitant uterosacral ligament suspension or sacrospinous ligament fixation.
• The primary outcome was reoperation or pessary use occurring more than 30 days after the index surgery; secondary outcomes were surgical retreatment alone, pessary use, and dyspareunia diagnosis; short-term complications occurring within 30 days were also assessed.
• Propensity score matching was performed, resulting in a matched cohort of 6964 women in each group.
• The long-term follow-up subgroup included 3375 women — 876 who underwent hysteropexy and 2499 who underwent hysterectomy — with a median follow-up of 8.7 and 9.1 years, respectively.

TAKEAWAY

• For short-term outcomes in the matched cohorts, hysteropexy vs hysterectomy was associated with lower rates of urinary retention (hazard ratio [HR], 0.78; 95% CI, 0.70-0.87) and urinary tract infection (HR, 0.79; 95% CI, 0.70-0.90).
• For long-term outcomes in the matched cohorts, hysteropexy was associated with a higher risk for prolapse reoperation than hysterectomy (HR, 1.77; 95% CI, 1.27-2.45).
• Overall prolapse retreatment rate (including reoperation and pessary use) was higher in the hysteropexy group than in the hysterectomy group (HR, 1.63; 95% CI, 1.24-2.14).
• Among women undergoing hysteropexy, subsequent hysterectomy occurred in 2.9% of patients during the long-term follow-up.

IN PRACTICE

“[The findings] highlight data on any retreatment, including pessary and surgical retreatment, giving a more accurate description of what patients might expect regarding surgical success. Our findings may be explained by the longer follow-up, possibly revealing higher recurrence rates for hysteropexy procedures,” the authors wrote.

SOURCE

This study was led by Inbal Akavian, MD, MPH, of the Department of Obstetrics and Gynecology in the Hadassah Medical Organization and faculty of medicine at the Hebrew University of Jerusalem in Jerusalem, Israel. It was published online on July 9, 2026, in Obstetrics & Gynecology.

LIMITATIONS

The analysis depended on diagnostic and procedure codes, hence some important outcomes may not have been fully recorded or could have been misclassified. Researchers could not accurately determine the indication for subsequent hysterectomy. Most patients in the hysteropexy group underwent sacrospinous ligament suspension, and uterosacral ligament suspension was more common in the hysterectomy group, making it harder to assess how each specific surgery affected the outcomes.

DISCLOSURES

No specific funding was reported. The authors did not report any potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Among women undergoing hysteropexy, subsequent hysterectomy occurred in 2.9% of patients during the long-term follow-up.