Hysteropexy for stage 1 uterine prolapse to prevent recurrence: a systematic review and Dutch nationwide survey

Background: It is generally considered that women start experiencing bothersome complaints when a pelvic organ prolapse reaches stage 2. However, studies indicate that a stage 1 uterine prolapse can already cause symptoms and consensus on its treatment is lacking. The aim of this study is to identify the available literature and the clinical variance regarding concomitant surgical treatment for stage 1 uterine prolapse during surgical treatment for stage ≥ 2 anterior and/or posterior prolapse and to assess its effect on the risk of recurrence. Method: PubMed and Cochrane CENTRAL library were searched in July 2025. Studies reporting recurrence after surgical prolapse repair for stage ≥ 2 anterior and/or posterior compartment prolapse with or without concomitant hysteropexy for stage 1 uterine prolapse were included. Simultaneously, a survey regarding the clinical practice on surgical treatment of stage 1 uterine prolapse was set out to gynecologists in The Netherlands. Results: A total of 1416 records were retrieved. After screening, 16 records remained for full review. None of these studies reported the outcomes in the group of interest (i.e., stage 1 uterine prolapse). Corresponding authors were contacted for additional information on this subgroup. Three articles were included, one article performing and two not performing concomitant hysteropexy (e.g. Manchester Fothergill or Sacrospinous Hysteropexy). Reported recurrence rates were 18% in the group with concomitant hysteropexy and 20 and 60% in the groups without concomitant hysteropexy. Conclusion: This systematic review shows that literature on stage 1 uterine prolapse repair is lacking. The survey shows large clinical variance in the treatment approach of stage 1 uterine prolapse. A prospective study on the effectiveness of concomitant hysteropexy for stage 1 uterine prolapse is recommended.