International urogynecology journal · 2026
Patient Risk Factors for Incidental Pathology After Uterovaginal Surgery for Apical Prolapse: Systematic Review and Global Expert Consensus Statements.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sullivan Marie E, Vendramini Agustina, Cattani Laura, Geoffrion Roxana, Page Ann-Sophie, Gottipati Vinita, Wood Mackenzie, Kang Kaidi, Kluivers Kirsten, Gupta Ankita, Matthews Catherine A, DeLancey John O L, Swenson Carolyn, Larouche Maryse, Sinha Annika, Geynisman-Tan Julia, Pipitone Fernanda, Grimes Cara L
Аннотация
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: Of 4,148 screened records, 33 studies met the eligibility criteria. Meta-analysis showed that the pooled prevalence of malignant pathology at the time of surgery was 0.6% (95% CI 0.0-1.0%; I2 = 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.
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: Of 4,148 screened records, 33 studies met the eligibility criteria. Meta-analysis showed that the pooled prevalence of malignant pathology at the time of surgery was 0.6% (95% CI 0.0-1.0%; I2 = 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.