A Meta-analysis of the Efficacy of Different Surgical Methods in the Treatment of Uterine Prolapse

Abstract

AIM: The management of uterine prolapse poses a significant clinical challenge, with surgical intervention often necessary for symptom relief and restoration of pelvic floor function. However, the optimal surgical approach for uterine prolapse remains uncertain, prompting a comprehensive meta-analysis to compare the efficacy of various surgical methods. This study aims to assess the effectiveness of different surgical methods for treating uterine prolapse.

METHODS: We used computer search to retrieve relevant literature to compare the therapeutic effects of different surgical methods for treating uterine prolapse. The search was conducted in the Web of Science and PubMed databases, and articles published until October 2023 were obtained. We employed random effects and fixed effects models and performed a meta-analysis using the R software.

RESULTS: This study included 40 standard papers covering 25,896 patients with uterine prolapse. We used random and fixed effects models to conduct a meta-analysis of hysterectomy and uterine fixation procedures. The findings indicated that different surgical approaches had no significant impact on surgical success rates (I² = 69%, p < 0.01; risk ratio (RR) (95% confidence intervals (CI)): 1.00 [0.98; 1.03]) or postoperative adverse reactions (I² = 54%, p < 0.01; RR (95% CI), 1.10 [0.83; 1.45]). However, the durations of the surgical procedure for hysterectomy (I² = 91%, p < 0.01; standardized mean difference (SMD) (95% CI), 0.78 [0.49; 1.07]), surgical blood loss (I² = 97%, p < 0.01, SMD (95% CI): 1.14 [0.21; 2.07]), and intraoperative adverse reactions (I² = 0%, p = 0.61, RR (95% CI): 1.37 [1.10; 1.71]) were statistically significant between hysterectomy and uterine fixation procedures. Additionally, publication bias and sensitivity tests showed no publication bias in this meta-analysis and no literature causing significant sensitivity.

CONCLUSIONS: In the treatment of uterine prolapse, both hysterectomy and uterine fixation are similar in terms of surgical success rates and postoperative adverse reactions. However, hysterectomy is associated with longer duration of the surgical procedure, increased blood loss and higher incidence of intraoperative adverse reactions compared to uterine fixation.