Single-port laparoscopic lateral suspension with total versus subtotal hysterectomy for pelvic organ prolapse: a prospective comparative study

BACKGROUND: Laparoscopic lateral suspension (LLS) is an effective mesh-based repair for pelvic organ prolapse (POP), but the optimal concomitant hysterectomy strategy - total (TH) versus subtotal (STH) - remains undefined. We compared anatomic outcomes, patient-reported outcomes, and complication profiles of LLS combined with TH (LLSHR) versus LLS combined with STH (LLSHE) in a prospective cohort of women who made an informed choice between the two procedures. METHODS: In this prospective comparative study conducted at Chengdu Integrated TCM & Western Medicine Hospital between October 2021 and October 2024, 82 women with symptomatic POP-Q stage II or III uterovaginal prolapse were counseled regarding both hysterectomy options and self-selected into the LLSHR group (n = 41) or the LLSHE group (n = 41). The study was approved by the institutional review board (IRB 2021.XJS.019) and retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2600118158). Primary outcomes were POP-Q point C and PISQ-12 score at 12 months. Secondary outcomes included POP-Q points Ba and Bp, PFDI-20, PFIQ-7, operative parameters, and mesh-related complications through 24 months. RESULTS: All 82 participants completed surgery as planned. At 12 months, point C was significantly more negative in the LLSHE group than in the LLSHR group (- 5.1 ± 0.5 cm vs. -4.5 ± 0.6 cm; P < 0.001), indicating superior apical support with cervical preservation. The PISQ-12 score at 12 months was significantly higher (better) in the LLSHE group (37.5 [IQR 33.0-42.5] vs. 31.0 [27.0-34.0]; P < 0.001). PFDI-20 and PFIQ-7 improved substantially in both groups with no between-group difference at any time point (all P > 0.05). At 24 months, point C remained significantly more negative in the LLSHE group (- 4.8 ± 0.5 vs. -4.4 ± 0.6; P = 0.004), and the PISQ-12 advantage of LLSHE persisted (37.0 [34.0-43.0] vs. 31.5 [26.8-39.0]; P = 0.005). Mesh exposure was observed in 3 patients (9.4%) in the LLSHR group and none in the LLSHE group (P = 0.226). Operative time was significantly shorter in the LLSHE group (149.0 [143.0-165.0] min vs. 171.0 [150.0-186.0] min; P = 0.002). CONCLUSIONS: In women undergoing LLS for POP, STH was associated with superior apical support and better sexual function at both 12 and 24 months, with shorter operative time and a numerically lower rate of mesh exposure compared with TH. Given the non-randomized design, these findings should be interpreted as hypothesis-generating. Prospective randomized trials are warranted to confirm these associations. TRIAL REGISTRATION: ChiCTR2600118158; registered February 2, 2026, retrospectively registered.