6 New procedures for uterine prolapse Azar Khunda, MRCOG, Subspecialty Fellow in Urogynaecology * , Arvind Vashisht, MA MD, MRCOG, Consultant Urogynaecologist, Alfred Cutner, MD, FRCOG, Consultant Gynaecologist UCLH Urogynaecology and Pelvic Floor Unit, University College Hospital, 235 Euston Road, London NW1 2BU, UK Keywords: sacrospinous hysteropexy sacrohysteropexy uterine suspension prolapse Traditionally, vaginal hysterectomy and Manchester repair were the surgical approaches to treating uterine prolapse; however, both are associated with a relatively high subsequent vaginal vault recurrence. Laparoscopic uterine suspension is a new way of maintaining uterine support. Many women are keen to keep their uterus for a variety of reasons, including maintaining reproductive capability and the belief that the uterus, cervix, or both, may play a part of their gender identity. Non-removal of the uterus may retain functional (e.g. bowel, bladder and sexual) benefits. There- fore, the concept of uterine preservation for pelvic-organ prolapse has been of interest to pelvic-floor surgeons for many decades. In this review, we provide an overview of the available evidence on treating uterine prolapse surgically. We describe techniques to support the vault during hysterectomy, and examine the evidence for uterine-sparing surgery. Comparative outcomes for vaginal, abdominal and laparoscopic routes will be made. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Uterovaginal prolapse is a common problem affecting women of all ages. It affects 50% of parous women over 50 years of age, with a lifetime prevalence risk of 30–50%. 1 A large retrospective study of US women found that, by the age of 80 years,11% of women have undergone surgery for urogynaecological complaints, and almost a one-third require repeat surgery. 2 This high recurrence rate has driven attempts to gain a better understanding of prolapse and the development of more robust techniques. For women presenting with urogynaecological problems, one size does not fit all. The surgeon’s goal should be to offer a range of procedures and to individualise surgery according to needs. Treatment * Corresponding author. Tel.: þ44 7866570058. E-mail address: azarkhunda@yahoo.co.uk (A. Khunda). Contents lists available at SciVerse ScienceDirect Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn 1521-6934/$ – see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bpobgyn.2012.12.004 Best Practice & Research Clinical Obstetrics and Gynaecology xxx (2013) 1–17 Please cite this article in press as: Khunda A, et al., New procedures for uterine prolapse, Best Practice & Research Clinical Obstetrics and Gynaecology (2013), http://dx.doi.org/10.1016/j.bpobgyn.2012.12.004