(Poster 32) Uterine Preservation and Prolapse Surgery Practices - An Online Survey

Objectives: To investigate surgeon demographics, practices, and preferences in apical prolapse repair, with a focus on uterine preservation.

Methods:

Design: Cross-sectional online survey.
Participants: Surgeons of academic institutions were invited to participate.
Interventions: A 48-item online survey assessed surgeon demographics, surgical practices, and preferences regarding uterine preservation in apical prolapse repair, including suture selection, surgical approach, and concerns related to hysteropexy.

Results: The survey, distributed via Qualtrics, was accessed by 64 surgeons; one declined participation, and one had incomplete data, leaving 62 respondents. Among them, 33 (53.2%) were female, and 29 (46.8%) were male. The most common age groups were 41–50 years (37.1%) and 51–60 years (27.4%). A total of 33.9% practiced in the United States. Most (95.0%) completed residency in obstetrics and gynecology, and 78.7% pursued fellowship training, primarily in urogynecology (95.8%). Regarding practice settings, 40.5% worked in academic institutions, and 26.1% practiced in both private and academic settings.
Hysteropexy was offered by 77.4% of surgeons. Sacrospinous hysteropexy was the most preferred approach (63.9%), followed by sacrohysteropexy (22.2%) and uterosacral hysteropexy (11.1%). Among those performing sacrospinous hysteropexy, 72.9% used a suture-anchoring device (e.g., Capio, Anchosure), while 18.8% used a Deschamps or Miya hook. For sacrohysteropexy, 39.1% attached both the anterior and posterior vaginal walls to the mesh before securing it to the anterior longitudinal ligament, while 30.4% anchored only the cervix. Preferred suture materials for sacrohysteropexy included polydioxanone (PDS™) (31.5%) and polytetrafluoroethylene (Gore-Tex™) (21.4%).
Among the 22.6% of surgeons who did not offer hysteropexy, the most common reasons were concerns about future uterine pathology complicating hysterectomy (27.9%) and a preference for hysterectomy-based repairs (18.6%). Additionally, 46.5% selected "other" reasons, and 6.98% cited lack of training. Universal cystoscopy was performed by 53.2% of respondents.

Conclusions: These findings highlight current trends in uterine preservation during apical prolapse repair, with sacrospinous hysteropexy as the most preferred approach. Variability in techniques, suture materials, and decision-making suggests a need for further studies to establish best practices and assess long-term outcomes.