IUGA Meeting 2023 - Balloon Debate - Uterine Descent

Several experts graced the IUGA stage to debate the best treatment for pelvic organ prolapse with uterine descent. Dr. Philip Toozs-Hobson argued that the vaginal hysterectomy has stood the test of time with long-term efficacy and low complication rates. While vaginal hysterectomy has been compared to hysteropexy with similar short-term outcomes, he argued that we do not have the long-term data needed to truly understand the hysteropexy outcomes. Dr. Julian Labrie had the job of arguing for the Manchester procedure for uterine descent and cited studies in which more women may prefer uterine preservation if the procedure is non-inferior in efficacy.  He reported results from Manchester procedure studies with very low complication risks compared to vaginal hysterectomy and similar efficacy to high uterosacral ligament suspension. He concluded that the Manchester procedure is a simple, effective, and safe procedure that should be considered for uterine descent. Dr. Federico Spelzini argued the high uterosacral ligament suspension side of the debate. He reports that this procedure has been around for more than 100 years but has been gaining popularity as time goes on. This procedure is the only procedure that aims to restore the normal anatomy for the treatment of uterine descent. This can be approached vaginally, laparoscopically, or abdominally which makes it accessible to all urogynecologic surgeons and can be done without the use of grafts. Dr. Hugo Van Eijndhoven gave us the opening statement, "The sacrospinous ligament is your best friend." He focused on the high subjective success rates after sacrospinous hysteropexy.  

After Round 1, the audience voted off Dr. Spelzini and the high uterosacral ligament suspension. The remaining three candidates argued their case again in an attempt to try to convince the audience that their procedure was the best. A vaginal hysterectomy was then voted off in Round 2 with Dr. Toozs-Hobson. The remaining two candidates had a chance at rebuttal. Ultimately, our "best friend," the sacrospinous ligament fixation, won the day beating out the Manchester procedure by a hefty margin. All in good fun, a lot of healthy competition and learning took place at this year's balloon debate!