Uterine preservation in pelvic organ prolapse

Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life and frequently requires surgical management. Historically, hysterectomy was considered the standard approach to prolapse repair; however, increasing recognition of patient preference and advances in surgical techniques have led to greater adoption of uterine-preserving procedures. Hysteropexy has emerged as a viable alternative to hysterectomy in appropriately selected patients. This review summarizes current evidence regarding uterine-preserving surgical approaches for POP, with a focus on patient selection, surgical techniques, and comparative outcomes.

This narrative review was developed through a comprehensive review of the available literature on uterine-preserving surgery for POP. Studies were selected based on relevance to uterine-preserving prolapse repair, with emphasis placed on high-quality evidence, including randomized controlled trials, systematic reviews, meta-analyses, large observational studies, and contemporary publications. Historical studies were included when relevant to the development and evolution of specific surgical techniques.

This review summarizes current evidence regarding uterine-preserving surgical approaches for POP, with a focus on patient selection, surgical techniques, and comparative outcomes. Available data suggest that hysteropexy provides similar short- to intermediate-term anatomic and subjective outcomes compared with hysterectomy with apical suspension. Uterine preservation is associated with decreased operative time, reduced blood loss, and, in mesh-augmented repairs, a lower risk of mesh exposure.Multiple surgical approaches are described, including vaginal, abdominal, laparoscopic, and robotic techniques, each with distinct advantages and limitations. Patient preference remains a key driver in decision-making, with many individuals favoring uterine conservation for personal, cultural, and psychosocial reasons. However, factors such as advanced prolapse, cervical elongation, and risk of gynecologic malignancy must be carefully considered.

Overall, hysteropexy represents a safe and effective option for the management of POP, although long-term durability data remain limited. Continued research is needed to better define optimal patient selection and long-term outcomes.