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Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse
Open accessAbstract
Objective The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation.Study design This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression.Results Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation.Conclusion A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for a sense of self were predictors of preference for uterine preservation.
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“a survey of patient preferences for POP surgery found that up to 36% of respondents favored uterine preservation if outcomes were equivalent [11].”
From Perioperative complications of laparoscopic sacrohysteropexy versus sacrocolpopexy with subtotal hysterectomy for pelvic organ prolapse (2026) · cites this paper as [11]
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Cites
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Hysterectomy Rates in the United States, 2003
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Inpatient hysterectomy surveillance in the United States, 2000-2004
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Hagen, S., & Stark, D. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003882.pub4 · Cited by 326
Attitudes Toward Hysterectomy in Women Undergoing Evaluation for Uterovaginal Prolapse
Frick, A. C., Barber, M. D., Paraiso, M. F. R., Ridgeway, B., Jelovsek, J. E., & Walters, M. D. (2013) · Female Pelvic Medicine & Reconstructive Surgery · doi:10.1097/spv.0b013e31827d8667 · Cited by 149
The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA
Shah, A. D., Kohli, N., Rajan, S. S., & Hoyte, L. P. J. (2007) · International Urogynecology Journal · doi:10.1007/s00192-007-0457-y · Cited by 147
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Predictors of Hysterectomy Use and Satisfaction
Kuppermann, M., Learman, L. A., Schembri, M. E., Gregorich, S. E., Jackson, R., Jacoby, A. F., Lewis, J., & Washington, A. E. (2010) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e3181cf46a0 · Cited by 46
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Meriwether, K. V., Antosh, D. D., Olivera, C. K., Kim-Fine, S., Balk, E. M., Murphy, M., Grimes, C. L., Sleemi, A., Singh, R., Dieter, A. A., et al. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.01.018 · Cited by 254
Detollenaere, R. J., den Boon, J., Stekelenburg, J., IntHout, J., Vierhout, M. E., Kluivers, K. B., & van Eijndhoven, H. W. F. (2015) · BMJ · doi:10.1136/bmj.h3717 · Cited by 194
Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214
(2019) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000003519 · Cited by 187
The American College of Obstetricians and Gynecologists and the American Urogynecologic Society INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. (2019) · Urogynecology · doi:10.1097/spv.0000000000000794 · Cited by 154
Metadata
- Authors
- Korbly, N. B., Kassis, N. C., Good, M. M., Richardson, M. L., Book, N. M., Yip, S., Saguan, D., Gross, C., Evans, J., Lopes, V. V., Harvie, H. S., & Sung, V. W.
- Affiliations
- Brown University (US)
- Indiana University Hospital (US)
- Stanford Medicine (US)
- Riverside Methodist Hospital (US)
- Yale University (US)
- Emory University (US)
- Cleveland Clinic Florida (US)
- Christ Hospital (US)
- University of Pennsylvania (US)
- Corresponding author
- Korbly, Nicole B.
- ORCID
- Harvie, Heidi S.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 209
- Issue
- 5
- Pages
- 470.e1-470.e6
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2043921323
- Cited by
- 211
- References
- 15
- Citations by year
- 2026: 12 · 2025: 22 · 2024: 20 · 2023: 18 · 2022: 21 · 2021: 22 · 2020: 18 · 2019: 20 · 2018: 18 · 2017: 18 · 2016: 9 · 2015: 7 · 2014: 5 · 2013: 1
- FWCI
- 6.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Society of Gynecologic Surgeons
- Topics
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- pelvic organ prolapse, uterine preservation, hysterectomy, patient preferences, treatment preferences, regional variation, educational attainment, selfhood
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Educational Status, Female, Geography, Humans, Hysterectomy, Middle Aged, Surveys and Questionnaires, Self Concept, United States, Uterine Prolapse, Multivariate Analysis, Logistic Models, Odds Ratio, Pelvic Organ Prolapse, Patient Preference, Organ Sparing Treatments
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