Highlights
- •Vaginal bilateral salpingo-oophorectomy is feasible at the time of vaginal hysterectomy for pelvic organ prolapse and more likely to succeed when intention to complete vaginally is high.
Abstract
Objective
The objective of this study was to determine the incidence of successful bilateral
salpingo-oophorectomy at the time of vaginal hysterectomy for pelvic organ prolapse
and to evaluate associated factors and success rate over time.
Study design
This was a retrospective chart review of all women who underwent vaginal hysterectomy
for pelvic organ prolapse who were consented for bilateral salpingo-oophorectomy “if
possible” and “including extraordinary measures” between 2014 and 2019 at a tertiary
medical center. Baseline demographic data along with prolapse stage, operative findings,
operative time, and complications were recorded. Univariate analysis using the Pearson’s
chi-square test, the student’s t-test or Mann Whitney U test when appropriate and multivariable logistic regression was performed to determine
predictors of successful vaginal bilateral salpingo-oophorectomy.
Results
A total of 453 eligible patients were included. 420 patients (92.7 %) were consented
for bilateral salpingo-oophorectomy “if possible” and 33 patients (7.3 %) were consented
for “including extraordinary measures”. The success rate of vaginal bilateral salpingo-oophorectomy
in all patients was 57.9 % (n = 262). Of the patients consented for extraordinary
measures, the success rate was 93.9 % (n = 31), compared to a success rate of 55 %
(n = 231) in the “if possible” group. A concurrent posterior repair was found to have
higher odds of successful bilateral salpingo-oophorectomy (adjOR 1.75 [95 % CI = 1.17–2.61]).
Successful bilateral salpingo-oophorectomy extended operative time by 14 min (154 min
vs 140 min, p < 0.001). Compared to patients in the unsuccessful group, the successful
group had a higher proportion of the following indications: a family history of ovarian
cancer, personal breast cancer history or patient request for definitive removal.
Conclusion
When the pre-operative intention to perform bilateral salpingo-oophorectomy at the
time of vaginal hysterectomy for pelvic organ prolapse is high, the success rate is
nearly 40% higher when compared to an opportunistic procedure. This suggests that
success is closely linked to the surgeon’s determination to complete this procedure
vaginally.
Keywords
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References
- Prophylactic and risk-reducing bilateral salpingo-oophorectomy: Recommendations based on risk of ovarian cancer.Obstet Gynecol. 2010; 116: 733-743
- ESHRE guideline: endometriosis.Hum Reprod Open. 2022; 2022https://doi.org/10.1093/hropen/hoac009
- Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study.Obstet Gynecol. 2009; 113: 1027-1037
- Risk of oophorectomy after hysterectomy.Obstet Gynecol. 2013; 121: 1069-1074
Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;129(6):e155–9. Doi: 10.1097/AOG.0000000000002112.
Cohen Sarah L., Vitonis Allison F., Einarsson Jon I. Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. J Soc Laparoendosc Surg. 2014;18(3). Doi: 10.4293/JSLS.2014.00096.
- Adnexal surgery at the time of hysterectomy in women 65 years and older undergoing hysterectomy for prolapse: do practice trends differ by route of surgery?.Int Urogynecol J. 2021; 32: 2185-2193
- The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.Am J Obstet Gynecol. 1996; 175: 10-17
- Factors affecting prophylactic oophorectomy in postmenopausal women.Obstet Gynecol. 1999; 94: 962-968https://doi.org/10.1016/s0029-7844(99)00452-4
- Predictors of successful salpingo-oophorectomy at the time of vaginal hysterectomy.J Minim Invasive Gynecol. 2012; 19: 58-62https://doi.org/10.1016/j.jmig.2011.09.008
- Factors affecting the feasibility of bilateral salpingo-oophorectomy during vaginal hysterectomy for uterine prolapse.Aust New Zeal J Obstet Gynaecol. 2011; 51: 307-309https://doi.org/10.1111/j.1479-828X.2011.01323.x
- Feasibility of prophylactic salpingectomy during vaginal hysterectomy.Am J Obstet Gynecol. 2017; 217: 605.e1-605.e5https://doi.org/10.1016/j.ajog.2017.07.017
- Feasibility of Oophorectomy at the Time of Vaginal Hysterectomy in Patients with Pelvic Organ Prolapse.J Minim Invasive Gynecol. 2019; 26: 1063-1069https://doi.org/10.1016/j.jmig.2018.10.010
SGO Clinical Practice Statement : Salpingectomy for Ovarian Cancer Prevention 2013;204(1):2–3.
Opportunistic salpingectomy as a strategy for epithelia ovarian cancer prevention. ACOG Committee Opinion No. 774. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2019;133:e279-84.
- The feasibility and safety of transvaginal bilateral salpingo-oophorectomy.Int J Gynecol Obstet. 2018; 141: 344-348https://doi.org/10.1002/ijgo.12458
- Prophylactic bilateral oophorectomy during vaginal hysterectomy for benign pathology.Arch Gynecol Obstet. 2009; 280: 87-90https://doi.org/10.1007/s00404-008-0879-x
- Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse.Int Urogynecol J. 2020; 31: 373-379https://doi.org/10.1007/s00192-019-03967-0
- Transvaginal mobilization and removal of ovaries and fallopian tubes after vaginal hysterectomy.Obstet Gynecol. 1996; 87: 35-39https://doi.org/10.1016/0029-7844(95)00346-0
Article info
Publication history
Published online: February 01, 2023
Accepted:
January 28,
2023
Received in revised form:
January 23,
2023
Received:
October 21,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
