How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse?
Abstract
Increasingly, uterine preservation surgeries are being performed for treating apical prolapse. Several types of procedures and surgical approaches to correct apical prolapse have been described in the literature. Despite this, there remains inadequate information to provide evidence-based recommendations regarding the optimal treatment approach and materials to use, and trials are ongoing to identify the optimal techniques. In the future, our patients may be the strongest determining influence when it comes to choice of apical prolapse surgery, with factors such as autonomy, reproduction, intimacy and fear influencing their decision. It is our opinion that the two most powerful forces behind the choice of apical POP surgical technique are the woman's personal desire for uterine preservation or not and the surgeon's personal choice of procedure based on training received. Present management of apical prolapse involves understanding patient goals and acknowledging their treatment preferences and values.
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The uterus acts as a 'keystone' of pelvic support, which explains the lower prolapse recurrence observed with uterine-preserving surgery.
“This finding is consistent with the uterus acting as a 'keystone' of pelvic support.61”
From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [61]
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Schulten, S. F., Detollenaere, R. J., IntHout, J., Kluivers, K. B., & Van Eijndhoven, H. W. (2022) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2022.04.017 · Cited by 39 · see citing works
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- Authors
- Anglim, B., O’Sullivan, O., & O’Reilly, B.
- Affiliations
- Cork University Hospital (IE)
- University College Cork (IE)
- Corresponding author
- Anglim, Breffini
- Venue
- International Urogynecology Journal
- Published
- 2018-06-11
- Volume
- 29
- Issue
- 8
- Pages
- 1075-1079
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W2808382725
- Cited by
- 31
- References
- 23
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 7 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 7
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- apical pelvic organ prolapse, uterine preservation, hysterectomy, patient decision-making, surgeon decision-making, treatment preferences, patient autonomy, reproductive goals, intimate relationships
- MeSH terms
- Female, Humans, Hysterectomy, Gynecologic Surgical Procedures, Uterus, Treatment Outcome, Pelvic Organ Prolapse, Organ Sparing Treatments, Surgeons
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