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Reconstructive Surgery at Hysterectomy for Patients With Uterine Prolapse and Gynecologic Malignancy
Rasika R Deshpande1, Olivia B Foy, Rachel S Mandelbaum
1Division of Gynecologic Oncology, the Division of Reproductive Endocrinology & Infertility, and the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, the Keck School of Medicine, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York.
Women with uterine prolapse undergoing hysterectomy are less likely to receive pelvic reconstructive surgery if they also have gynecologic malignancy or premalignancy. This national study highlights a disparity in surgical care for these patients.
Area of Science:
- Pelvic reconstructive surgery
- Gynecologic oncology
- Urogynecology
Background:
- Uterine prolapse is a common condition affecting women's pelvic floor health.
- Hysterectomy is a surgical procedure often performed for uterine prolapse.
- Pelvic floor reconstruction aims to restore function and alleviate symptoms.
Purpose of the Study:
- To assess the likelihood of receiving reconstructive surgery during hysterectomy for uterine prolapse.
- To investigate the impact of coexisting gynecologic malignancy or premalignancy on reconstructive surgery rates.
- To analyze national-level data on surgical practices for uterine prolapse patients.
Main Methods:
- Cross-sectional study design.
- Analysis of 211,708 patients diagnosed with uterine prolapse undergoing hysterectomy (2016-2019).
- Data sourced from the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample.
Main Results:
- Patients with uterine prolapse and gynecologic malignancy (1.1%) were less likely to receive reconstructive surgery (OR 0.90).
- This trend was more pronounced in cases of complete uterine prolapse with malignancy (OR 0.68).
- Similar findings were observed for patients with coexisting gynecologic premalignancy (1.6%).
Conclusions:
- Patients with uterine prolapse and coexisting gynecologic malignancy or premalignancy appear to receive less reconstructive surgery.
- This national assessment indicates a potential underutilization of pelvic floor repair in this patient group.
- Further research is needed to understand the reasons behind this disparity.
