Hysterosacropexy and cervicosacropexy in the treatment of pelvic organ prolapse may provide an anatomical and subjective improvement, particularly in the apical compartment. Because of the lack of high-quality research involving large sample sizes in this field there is no consensus about uterus preservation during pelvic reconstructive surgery in the apical compartment [1, 2]. It has been hypothesized the uterus may hinder the attachment of the anterior graft in case of hysterosacropexy, which may lead to an increase in both patient discomfort/dyspareunia and the risk of recurrent prolapse [1]. The aim of the study was to determine whether, in the treatment of uterovaginal prolapse, supracervical hysterectomy and cervicosacropexy with polypropylene mesh is associated with better objective and subjective efficacy of the procedure and less dyspareunia rate than the hysterosacropexy with uterus preservation.

The study methods and definitions conformed to the standards jointly recommended by the International Continence Society. The study groups included patients with symptomatic apical prolapse, stages IIIC or IVC, based on the POP-Q system, who had undergone hysterosacropexy or supracervical hysterectomy and cervicosacropexy with polypropylene mesh. The database contained records of a total of 15 Caucasian women operated between January 2014 and  January 2017 i.e. the hysterosacropexy (n=7) and the supracervical hysterectomy and cervicosacropexy (n=8). The route of the surgical  procedures were mostly laparoscopy (n=11), in 3 cases laparotomy, and in 1 case laparoscopy with conversion to laparotomy. For all the patients, a follow-up assessment was performed at 12±3 months postoperatively. The vaginal bulge symptoms were assessed using a question selected from the Pelvic Floor Distress Inventory ('Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?') [3]. Retreatment for POP was defined as any repeat surgery or the use of pessary for a recurrent anterior and/or apical descent. The patients were interviewed about SUI symptoms using the Stamey Incontinence Score. The OAB symptoms were assessed using questions selected from the Pelvic Floor Distress Inventory ('Do you usually experience frequent urination?', 'Do you usually experience a strong feeling of urgency to empty your bladder?', 'Do you usually experience urine leakage associated with feeling of urgency, that is, a strong sensation of needing to go to the bathroom?') [3]. The postoperative pain severity was estimated by the patient using a five point scale based on the IUGA/ICS grading system for the assessment of mesh-related pain. Dyspareunia was assessed with the question 'Do you have pain with intercourse?. The subjective postoperative patient satisfaction was assessed using the Patient Global Impression of Improvement (PGI-I).

There were no between-group differences in age of the study groups and in measures of efficacy (bulge symptoms, POP-Q stage 0 or I, absence of anterior, posterior or apical descent beyond the hymen and no retreatment for POP). The accurate correction of the pelvic organ prolapse was achieved in all patients. The mean apical POP-Q stage assessed on the follow-up evaluation did not differ between the groups (p values >0.05). There were no cases of vaginal mesh erosion/exposure, de novo SUI, vaginal pain and dyspareunia in the hysterosacropexy and cervicosacropexy groups. Patients' responses to PGI-I were distributed to "much better" and "very much better" with a mean score of 1.42 in hysterosacropexy and 1.25 cervicosacropexy group (p>0.05). There were no between-group differences in the proportion of women reporting de novo OAB symptoms (n=1 in hysterosacropexy group, n=1 in cervicosacropexy group; p values >0.05). One case of rectal trauma with bleeding on the first day after surgery in the cervicosacropexy group was observed, but it was cured conservatively.

Our one centre initial study on small number of patients showed the high and comparable objective and subjective efficacy rate and patients' postoperative satisfaction in the two groups of women following the hysterosacropexy or supracervical hysterectomy and cervicosacropexy with polypropylene mesh procedure. 
Further prospective studies on large group of patients are mandatory to validate the results of the present study.

The hysterosacropexy and supracervical hysterectomy and cervicosacropexy with polypropylene mesh procedure are effective method in the management of pelvic organ prolapse in the apical compartment. Sacropexy with uterus preservation is not associated with worse objective and subjective efficacy and with more dyspareunia rate than the cervicosacropexy.

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