How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse?

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.