Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey)

Abstract

Background The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia. Results A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices. Conclusions The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.

Pelvic organ prolapse and uterine preservation: A cohort study (POP-UP study)

“…It is the technical challenge to achieve proper placement of the anterior mesh in LSH and be able to create a "de novo vaginal apex" that is considered to be a plausible reason for the higher anterior compartment failure in association with LSH and is the driver behind the suggestion of alternative modi cations to the standard technique [41]. The process of re ning the current LSH technique is crucially important since the number of women opting for uterine sparing surgery signi cantly falls if this technique is associated with inferior anatomical outcome [18,19].…”

Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study)

“…It is the technical challenge to achieve proper placement of the anterior mesh in LSH and be able to create a “de novo vaginal apex” that is considered to be a plausible reason for the higher anterior compartment failure in association with LSH and is the driver behind the suggestion of alternative modifications to the standard technique [ 41 ]. The process of refining the current LSH technique is crucially important since the number of women opting for uterine sparing surgery significantly falls if this technique is associated with inferior anatomical outcome [ 18 , 19 ].…”

“…The American College of Obstetricians and Gynecologists considers involving and supporting patients in the discussion about uterine preservation in elective surgery as obligatory [ 17 ]. Furthermore, there seems to be an increasing tendency for women to explore uterine preserving procedures for their POP surgical management rather than just accept a hysterectomy [ 18 – 20 ]. Therefore, increasing the availability of options, that do not necessitate a hysterectomy, gives women viable options to individualize their POP management plan.…”

“…Therefore, increasing the availability of options, that do not necessitate a hysterectomy, gives women viable options to individualize their POP management plan. Nonetheless, one of the important determinants of women’s choice about uterine preservation or concomitant hysterectomy is the outcome associated with either procedure [ 18 – 20 ]. There is evidence that the route of concomitant hysterectomy during LSC does not seem to be associated with the perioperative or postoperative outcomes [ 21 , 22 ].…”

Pelvic organ prolapse and uterine preservation: A cohort study (POP-UP study)

“…Based on the currently available evidence, LSC is the most commonly used laparoscopic method and this could be in the form of laparoscopic sacrohysteropexy (LSH), laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH+LSC) or total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH+LSC).The American College of Obstetricians and Gynecologists considers involving and supporting patients in the discussion about uterine preservation in elective surgery as obligatory [17]. Furthermore, there seems to be an increasing tendency for women to explore uterine preserving procedures for their POP surgical management rather than just accept a hysterectomy [18][19][20]. Therefore, increasing the availability of options, that do not necessitate a hysterectomy, gives women viable options to individualize their POP management plan.Nonetheless, one of the important determinants of women's choice about uterine preservation or concomitant hysterectomy is the outcome associated with either procedure [18][19][20].…”