What is the best available procedure for management of stage III uterine prolapse in young age women?
fertility conservation surgery
Young women may need Uterine preservation procedures as :
1- Sacrospinous hysteropexy.
2- Manchester repair (Fothergill's repair)
3- Sacrohysteropexy
The real answer to this question is that nobody knows as there are no randomised trials done to date except for vaginal hysterectomy vs sacrospinous fixation.
The on going randomised VUE study may shed some light although its out come measure is not focused on fertility.
At present the best option appears to be a laparoscopic hysteropexy (open hysteropexy is an option but more invasive) There are also reported pregnancies with sacrospinous hysteropexy.
Support vaginal pessaries are also an option until the woman's family is complete
Dear Ahmed,
Just to add further, the Manchester repair which involves amputation of the cervix will not be recommended in a woman who wishes to preserve her fertility as it will be associated with mid trimester miscarriages and preterm labour. If the woman does get pregnant after this operation she will need a cervical cerclage (Shirodkar suture) which will be associated with an increased risk of bladder injury and a fistula.
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