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Updated: Oct 1, 2026
Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse
Published on: September 13, 2022
Patient Risk Factors for Incidental Pathology After Uterovaginal Surgery for Apical Prolapse: Systematic Review and
Marie E Sullivan1, Agustina Vendramini2, Laura Cattani3,4
1Department of Urogynecology and Pelvic Reconstructive Surgery, Wake Forest University, 140 Charlois Blvd, Winston Salem, NC, 27103, USA. marsulli@wakehealth.edu.
Introduction And Hypothesis:
Uterus preservation is increasingly used for uterovaginal prolapse (U-POP) repair despite ongoing concerns regarding future uterine, cervical, and adnexal pathology. We evaluated incidental pathology rates, associated risk factors, and created global consensus statements.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for studies including women undergoing U-POP surgery with uterus present in ≥ 50% and cohorts of ≥ 30 participants exploring risk factors for pathology. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions and evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Meta-analyses were performed on the proportions of incidental pathology. Findings informed a modified Delphi process resulting in consensus statements on best practice.
Results:
Of 4,148 screened records, 33 studies met the eligibility criteria. Meta-analysis showed that the pooled prevalence of malignant pathology at the time of surgery was 0.6% (95% CI 0.0-1.0%; I2 = 93.5%, p < 0.05), ranging from 0% to 3.2%. Most studies excluded patients with known malignancy risk factors. Among six uterus-preserving studies, meta-analysis showed that malignancy rates did not differ between screened and unscreened populations (0.50% vs 0.58%, p = 0.88). Six retrospective cohort studies identified risk factors for incidental endometrial malignancy: older age, higher uterine weight, and abnormal preoperative ultrasound each emerged in two studies, with no factor consistent across them. Three consensus statements were supported by high-quality evidence and three were accepted through Delphi consensus.
Conclusions:
Incidental pathology in U-POP surgery is rare (< 1%), and no single risk factor reliably predicts malignancy. Preoperative screening does not show significant reduced malignancy rates in uterus-preserving surgery. Global consensus statements offer guidance on when hysterectomy should be considered over uterus preservation.
