Long-Term Outcomes After Native Tissue Hysteropexy Compared With Hysterectomy for Treatment of Pelvic Organ Prolapse

OBJECTIVE: To compare long-term retreatment outcomes after native tissue hysteropexy and hysterectomy with apical suspension for apical pelvic organ prolapse. METHODS: This retrospective cohort study included women undergoing native tissue apical prolapse repair between November 1, 2005, and November 1, 2025, in U.S. health care organizations included in the TriNetX research network. Women were classified as having either uterine-preserving surgery (hysteropexy) or hysterectomy, both with concomitant apical suspension using either uterosacral ligament suspension or sacrospinous ligament fixation. Propensity score matching was performed to balance baseline demographic, clinical, and procedural characteristics. Short-term outcomes included postoperative complications occurring within 30 days of surgery. Long-term outcomes were assessed in women undergoing surgery before November 1, 2015. The primary outcome was prolapse retreatment , defined as reoperation or pessary use occurring 30 days or more after the index procedure. Time-to-event analyses were conducted with Cox proportional hazards models, with results reported as hazard ratios (HRs) and 95% CIs. RESULTS: The long-term follow-up cohort included 2,499 women in the hysterectomy group and 876 women in the hysteropexy group, with a median follow-up of 9.1 and 8.7 years, respectively. Among women undergoing hysteropexy, subsequent hysterectomy occurred in 26 patients (2.9%) during long-term follow-up. In the matched cohorts, hysteropexy was associated with a higher risk of prolapse reoperation compared with hysterectomy (11.1% vs 6.5%, HR 1.77, 95% CI, 1.27–2.45) and a higher overall prolapse retreatment rate (15.0% vs 9.6%, HR 1.63, 95% CI, 1.24–2.14). In short-term analyses, hysteropexy was associated with lower rates of urinary retention (8.5% vs 10.9%, HR 0.78, 95% CI, 0.70–0.87) and urinary tract infection (6.5% vs 8.2%, HR 0.79, 95% CI, 0.70–0.90) compared with hysterectomy in the matched cohorts. CONCLUSION: Native tissue hysteropexy is associated with a modestly higher long-term risk of prolapse retreatment compared with hysterectomy while demonstrating slightly lower rates of short-term postoperative complications.