Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse

Objective The aim of this study was to assess the risk of unanticipated abnormal gynecologic pathology at the time of reconstructive pelvic surgery to better understand risks of uterine conservation in the surgical treatment of uterovaginal prolapse. Study Design This was a retrospective analysis of pathology findings at hysterectomy with reconstructive pelvic surgery over a 3.5-year period. Results Seventeen of 644 patients had unanticipated premalignant or malignant uterine pathology (2.6%; 95% confidence interval, 1.7–4.2). Two (0.3%; 95% confidence interval, 0.09–1.1) had endometrial carcinoma. All cases of unanticipated disease were identified in postmenopausal women. Conclusion Premenopausal women with uterovaginal prolapse and normal bleeding patterns or with negative evaluation for abnormal uterine bleeding have a minimal risk of abnormal gynecologic pathology. In postmenopausal women without bleeding, the risk of unanticipated uterine pathology is 2.6% but may be reduced by preoperative endometrial evaluation. However, in women with a history of postmenopausal bleeding, even with a negative endometrial evaluation, we do not recommend uterine preservation at the time of prolapse surgery.