Patient Risk Factors for Incidental Pathology After Uterovaginal Surgery for Apical Prolapse: Systematic Review and Global Expert Consensus Statements
Year: 2026
Type: review
Study design: Systematic Review
Abstract: 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: = 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.
Authors: Marie E. Sullivan, Agustina Vendramini, Laura Cattani, Roxana Geoffrion, Ann-Sophie Page, Vinita Gottipati, Mackenzie Wood, Kaidi Kang, Kirsten Kluivers, Ankita Gupta, Catherine A. Matthews, John O. L. DeLancey, Carolyn Swenson, Maryse Larouche, Annika Sinha, Julia Geynisman-Tan, Fernanda Pipitone, Cara L. Grimes
Institutions: Wake Forest University, Hospital Donación Francisco Santojanni, Zuyderland Medisch Centrum, KU Leuven, University of British Columbia, Universitair Ziekenhuis Leuven, Albany Medical Center Hospital, Wake Forest University Health Sciences, Radboud University Medical Center, University of Louisville, University of Louisville Hospital, University of Michigan, Michigan Medicine, University of Utah, Duke University, Duke Medical Center, Northwestern University, Universidade de São Paulo, Albany Medical College
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,790
OpenAlex ID: W7214702809