To Remove or Preserve? The Modern Approach to Uterus in Prolapse Surgery

The standard approach to pelvic organ prolapse surgery is shifting. In the February 2026 AUA News feature, To Remove or Preserve? The Role of Hysterectomy in Prolapse Surgery, authors Tamar Yacoel, MD; Ruomei Wu, MD; Katherine Amin, MD; and Raveen Syan, MD from the University of Miami outline a growing trend toward uterine preservation during prolapse repair. The article highlights that surgery is increasingly guided by patient preferences, anatomical considerations, and clinical indications, rather than routine hysterectomy.

The authors explain that modern uterine-preserving procedures such as laparoscopic sacrohysteropexy, sacrospinous ligament fixation, and uterosacral ligament suspension provide durable anatomical outcomes, reduced blood loss, and shorter operative times. Beyond clinical success, retaining the uterus can preserve fertility, maintain hormonal function, and support emotional well-being for many women.

Despite these advantages, hysterectomy remains necessary in certain situations, including known or suspected uterine malignancy, unexplained postmenopausal bleeding, and significant uterine pathology. In these cases, hysterectomy can simplify surgical planning and address other health concerns while still delivering strong prolapse repair outcomes.

The key message from this feature is that prolapse surgery success is no longer defined by automatic removal of the uterus. Optimal outcomes rely on shared decision-making, careful patient counseling, and evidence-based surgical planning. Surgeons are encouraged to consider both preservation and removal strategies, tailoring the approach to each patient’s goals and health needs.

Read the Full Article: To Remove or Preserve? The Role of Hysterectomy in Prolapse Surgery

References:
Yacoel T, Wu R, Amin K, Syan R. To Remove or Preserve? The Role of Hysterectomy in Prolapse Surgery. Desai Sethi Urology Institute, University of Miami Miller School of Medicine. February 17, 2026.

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