Uterine preservation in pelvic organ prolapse

Pelvic organ prolapse (POP) is a highly prevalent condition affecting a large portion of adult women worldwide ( 1 ). Roughly 3% of women in the United States report symptomatic uterine prolapse and approximately one in five women will have surgery for POP or stress urinary incontinence by age 80 ( 2 , 3 ). POP has a significant impact on quality of life and remains one of the most common indications for pelvic reconstructive surgery. Historically, hysterectomy at the time of prolapse repair surgery was considered the standard of care, and consequently these surgeries are among the most common indications for benign hysterectomy in the United States ( 1 ). This practice was thought to lessen the degree or timeline for prolapse recurrence. As further understanding of pelvic floor support has evolved, providers have gained insight into the mechanism behind prolapse and recurrence, leading to a shift in the landscape of prolapse repair surgery, favoring more uterine-preserving approaches. Anatomical studies have demonstrated the uterus is not the cause of prolapse and, in fact, one of the risk factors for prolapse formation is hysterectomy ( 4 ). Without preexisting uterine pathology, benign hysterectomy introduces a higher level of morbidity at the time of surgery ( 5 ). Additionally, many patients have personal or cultural beliefs underlying their desire for uterine preservation ( 5 ), which should be taken into account at the time of surgical counseling. Taken together, uterine-sparing prolapse procedures have increased in prevalence over the past 20 years, as has level of data supporting the role for these procedures in clinical practice ( 6 ). The purpose of this review is to examine the current evidence supporting hysteropexy as an alternative to hysterectomy at the time of prolapse repair surgery.

Hysterectomy was widely accepted as a mainstay for pelvic reconstructive surgery for many years ( 7 ). Over time, however, research has demonstrated important negative patient perceptions regarding hysterectomy, and the associated desire to retain one’s uterus if outcomes were similar to hysterectomy ( 5 ). Additionally, media portrayal of hysterectomy has gained a negative light ( 8 ). Public-facing literature and patient advocacy sources have increasingly framed hysterectomy as a procedure to be avoided when alternatives exist ( 8 ). Patients report several motivations for desire to retain their uterus including maintenance of body integrity, sexual identity, and the psychological meaning of the uterus ( 9 ). Furthermore, a large systematic review including 12 randomized control trials and 41 nonrandomized control trials comparing prolapse surgery with and without hysterectomy demonstrated no difference in outcomes, but decreased blood loss and operative time with uterine preservation ( 5 ). This has led providers to reexamine the necessity of removing the uterus at the time of prolapse repair, resulting in greater adoption of uterine-preserving prolapse repair techniques in clinical practice. Present trends demonstrate that uterine-preserving prolapse procedures are increasing in popularity ( 6 ). This reflects both an increase in patient demand and surgeon experience with hysteropexy techniques. Many studies have shown the role of patient preference in driving these trends ( 8 ). This underscores the importance of surgeon familiarity with these procedures, many of which utilize the same techniques as their counterpart procedures performed after hysterectomy.

Comprehensive patient-centered counseling should be utilized to understand the most appropriate surgical approach when POP repair is planned. While there are many advantages associated with uterine preservation, there are important patient-considerations which influence the appropriateness of these procedures. In the absence of uterine pathology, uterine-preserving prolapse repair may offer several advantages, including decreased blood loss and operative time compared with hysterectomy-based repairs ( 5 ). Patients may also have personal, cultural, sexual, or identity-related reasons for desiring uterine preservation ( 5 , 9 ). For women of reproductive age, preservation of the uterus may be particularly desirable when future fertility remains important. Providers should discuss the patient’s reproductive plans, current contraceptive methods, and, if applicable, whether concurrent sterilization is desired at the time of POP repair when hysteropexy is planned. Lastly, hysteropexy may be advantageous for patients with obesity by mitigating challenges due to habitus associated with abdominal approaches and reducing operative time. Many patients may desire or be recommended to undergo hysterectomy to address abnormal uterine bleeding, heavy menstrual bleeding, or benign uterine disease such as fibroids or adenomyosis. Patients with a history of abnormal cervical cancer screening may also desire or be recommended to have a hysterectomy. Anatomic considerations important when evaluating for hysteropexy include uterine size and shape, stage of prolapse, and cervical or vaginal length. Uterine features concerning for abnormal pathology or clinical symptomatology may merit consideration for hysterectomy. Recent reviews have further emphasized that patient selection is critical when considering uterine preservation, particularly among patients with increased risk for gynecologic malignancy, hereditary cancer syndromes, endometrial hyperplasia, or postmenopausal bleeding requiring further evaluation ( 10 ). Cervical length can be evaluated on clinical examination when performing the POP-quantification (POP-Q) examination. The C-point in women with a uterus/cervix denotes the maximal point of descensus of the cervix with Valsalva. The D-point measures descensus of the posterior fornix with Valsalva. The difference between the D- and C-points can provide insight into whether cervical elongation exists, especially when combined with findings from the pelvic examination. With hysteropexy, the postoperative C-point may be less favorable when cervical elongation is present. Further, cervical elongation has been noted to be a predictive factor for failure following hysteropexy, with nearly a three-fold increased risk ( 11 ). While this is not an absolute contraindication to uterine-preserving prolapse repairs, consideration could be given to performing a concurrent partial trachelectomy to help address this anatomic finding, when present, or providers could prioritize a procedure such as the Manchester procedure, in which trachelectomy is a planned component of the repair. Also, hysterectomy, while addressing cervical elongation, may shorten total vaginal length through colpotomy creation ( 5 , 12 - 14 ). Consideration of POP-Q stage may also be important when selecting the surgical approach. For patients with advanced stage III or stage IV prolapse who do not desire future penetrative intercourse, a LeFort colpocleisis may be an ideal surgical approach given the very low prolapse recurrence rate. Conversely, for patients who wish to maintain a patent vaginal canal and have advanced stage III or IV POP, previous research has demonstrated higher apical recurrence rates in those who underwent hysteropexy compared to hysterectomy with vaginal native tissue repair ( 14 ). In the absence of indications for hysterectomy, it is important for providers to discuss the need for ongoing cervical cancer screening practices and menstruation when hysteropexy is pursued. Gynecologic cancer risk should be thoroughly discussed and considered. Overall, the lifetime cancer risk for the general postmenopausal population is 0.6% for cervical, 2.7% for endometrial, and 1.4% for ovarian malignancy ( 15 , 16 ). This risk can be increased by a variety of genetic and social factors, so obtaining a thorough patient and family history is crucial. A family history of malignancy, abnormal personal gynecologic screenings, elevated body mass index (BMI), and tobacco use are only a few examples of factors that should be carefully considered prior to offering uterine preservation ( 16 ). Inquiry regarding any history of postmenopausal bleeding, the evaluation pursued, and any associated tissue sampling should be reviewed. For those who report postmenopausal bleeding, it is prudent to perform a detailed physical examination, obtain a transvaginal ultrasound, and perform endometrial sampling when clinically indicated to further risk-stratify. Patients should be educated that in the absence of genetic predisposition, at-risk social behaviors, and symptoms concerning for malignancy, findings of early malignancy can still be found on the final uterine pathologic specimen obtained for benign indications ( 17 ).This risk is generally low, reported to be less than 1%, though it necessitates ongoing screening for malignancy ( 17 ). While hysteropexy may be advantageous for patients with obesity, the increased risk of future gynecologic malignancy, need for future endometrial sampling, and risk of prolapse recurrence are important considerations. Specifically, increased BMI is strongly associated with endometrial cancer ( 16 ).Further, increased weight is not only a significant risk factor for the incidence of POP, but also a modifiable factor influencing symptom severity ( 18 ). Therefore, these patients must be adequately counseled.

In the discussion of operative risk and benefit, uterine preservation alone is only one factor to consider. An equally important consideration is, when hysteropexy is desired, what approach is most appropriate for the given patient. Hysteropexy can be accomplished through a variety of different surgical techniques, including vaginal, abdominal, laparoscopic, and robotic-approaches. These can be performed utilizing the patient’s native tissue or be mesh-augmented and may result in a functional or an obliterated vaginal canal. A summary of uterine-preserving prolapse repair techniques is presented in Table 2 . SSLH, sacrospinous ligament hysteropexy; USLH, uterosacral ligament hysteropexy.

Cervical elongation was initially believed to be a contributing factor to the development of prolapse. The Manchester procedure, developed by Dr. Archibald Donald in the early 20th century, was one of the first surgical approaches to correct POP and was uterine-sparing. The surgery involves truncating the cervix, followed by plicating the cardinal and uterosacral ligaments. As the field progressed in the belief that POP was largely due to uterine descensus, the Manchester procedure fell out of favor. However, more contemporary data continues to support this approach as a viable option for prolapse repair. Given its historical prevalence, this approach was evaluated in the largest study on hysteropexy to date. This included nearly one thousand patients with a mean follow-up of greater than 10 years. Based on medical record review and survey responses, patients were found to have a recurrence rate of 4.3% ( 19 ). Further, when compared to other vaginal prolapse repairs with concurrent vaginal hysterectomy, the Manchester Procedure was associated with adequate durability and symptom control, shorter operative time (33.7 minutes) and less blood loss (103.6 mL) ( 5 , 20 ). Uterosacral ligament suspension of the uterus via transvaginal or abdominal approach is performed by shortening the uterosacral ligament. Vaginally, the peritoneal cavity is entered by making a posterior colpotomy, just inferior to the cervix, to enter the intraperitoneal cavity. The uterosacral ligaments are grasped at approximately the level of the ischial spine, similar to the technique described by Shull et al. for uterosacral ligament colpopexy, and delayed absorbable sutures are placed ( 21 , 22 ). The sutures are then anchored through the uterosacral ligament at its distal insertion and through the cervical stroma. The colpotomy is closed and the sutures are tied down, suspending the uterus and cervix cephalad to the level of the hysteropexy sutures. This can also be accomplished abdominally through a minimally invasive approach. The uterosacral ligaments are then plicated across the midline, cephalad to their insertion on the cervix. Given that this technique requires intraperitoneal entry, an added benefit is access to the adnexa and the ability to concurrently address any adnexal pathology or perform sterilization procedures. For women who have adnexal findings or desire sterilization, the uterosacral hysteropexy lends itself to these concurrent procedures and can be considered when selecting the appropriate surgical approach. In a retrospective chart review of 100 patients who underwent uterosacral ligament uterine hysteropexy, compared to those that underwent hysterectomy concomitantly with uterosacral ligament suspension, outcomes did not show statistical significance at follow-up at 2 years ( 13 ). In four nonrandomized control trials comparing laparoscopic uterosacral ligament hysteropexy to hysterectomy with reconstruction, prolapse recurrence was found to occur less frequent in the hysterectomy group, though there was no difference in reoperation or complication rates ( 5 ). The sacrospinous ligament hysteropexy is typically a unilateral apical support procedure, which utilizes an extraperitoneal dissection to the sacrospinous ligament. While this procedure can also be performed bilaterally and with mesh-augmentation, this will be discussed later in the article. An incision is made just inferior to the posterior cervix and the extraperitoneal dissection is performed. Alternatively, an anterior approach can be taken using the traditional anterior colporrhaphy incision to dissect inferolaterally to the sacrospinous ligament. Once dissection is complete at the ligament, delayed absorbable sutures with or without combination permanent suture are placed utilizing, most commonly, a disposable suture-ligature device. These can also be performed by either free suturing or with reusable ligature carriers. The sutures are then anchored through the posterior cervix and uterosacral ligaments, which results in uterine suspension when the sutures are tied down. This approach to hysteropexy carries some of the most robust data in the literature. The extraperitoneal approach lends itself to decreased operative time and reduced blood loss when compared to vaginal hysterectomy ( 14 ). Additionally, it avoids the risks associated with intraperitoneal procedures. And, when compared to sacrospinous ligament colpopexy for post-hysterectomy vaginal vault prolapse, hysteropexy was shown to have no difference in durability ( 12 ). In a multicenter randomized, non-inferiority trial, sacrospinous hysteropexy was shown to be non-inferior regarding symptom control and need for repeat surgery at 12 months when compared to vaginal hysterectomy with uterosacral ligament suspension ( 23 ). Data has been generally favorable in support of sacrospinous hysteropexy compared with vaginal hysterectomy, though a notable disadvantage is the objective C point on postoperative follow-up exam ( 12 ). A more recent study with long-term follow-up (77 months) comparing this sacrospinous ligament hysteropexy to vaginal hysterectomy with uterosacral ligament suspension, demonstrated relatively high satisfaction with the procedure (71% versus 70% in the hysterectomy group, P=0.90) ( 24 ). However, this study also demonstrated low subjective success rate in both groups, 45% in the vaginal hysterectomy with uterosacral ligament suspension, and 51% in the sacrospinous hysteropexy group, though there was no statistically significant difference between the two (P=0.54) ( 24 ). The LeFort colpocleisis is another procedure with historical significance that has shown to be a safe and effective procedure after nearly 150 years of practice. Leon Le Fort developed an exclusively vaginal approach for uterine-sparing prolapse repair in 1877 ( 1 ). It is also an obliterative procedure, and thus not suitable for individuals desiring a functional vagina. The LeFort colpocleisis involves removing a panel of epithelium from the anterior and posterior vaginal walls, preserving the ectocervix and a narrow channel along the lateral vagina on each side. The anterior and posterior walls are then plicated to each other for imbrication of the vagina. This obliterates the vaginal canal while maintaining small channels bilaterally to allow for secretions of the endometrium and cervix to drain. For post-menopausal patients who do not desire penetrative intercourse, this is a highly durable and minimally-invasive option for repair. Survey studies have demonstrated patients that undergo this procedure are highly satisfied, reported they would choose that procedure again, and denied regret over losing sexual function ( 25 ). This approach is also referred to as a partial colpocleisis, as a total would indicate the entire vaginal epithelium was removed and there would be no creation of channels. This is performed in the absence of a uterus, as there would not be a need for drainage of secretions. The LeFort, or partial, colpocleisis has been compared to total colpocleisis with total vaginal hysterectomy in retrospective studies. Those studies have shown similar anatomic outcomes, in the setting of lower blood loss and shorter operative times when the uterus is preserved with the LeFort technique ( 6 , 26 ).

Another historically significant approach involving uterine preservation is the mesh-augmented extraperitoneal hysteropexy procedure. This involved the use of transvaginal mesh kits, all of which are no longer in production. Mesh kits were popular in use prior to 2008. Application required perineal incisions that allowed blind passage of insertion needles. Mesh was placed vaginally into the obturator foramen and ischiorectal fossa. One of the more popular versions of the transvaginal mesh kits was the Uphold Vaginal Support System. This involved an inverted U incision on the anterior vaginal wall with dissection of the epithelium off of the underlying muscularis extending inferiorly to the vaginal apex. Dissection is then extended bilaterally into the pararectal space to allow for attachment of the Uphold device to the sacrospinous ligaments. This approach was studied in a large randomized control trial in comparison with total vaginal hysterectomy and uterosacral ligament suspension ( 27 ). This study demonstrated a lower composite failure rate, including need for retreatment, symptomatic or anatomic recurrence, of the Uphold procedure (37%) in comparison to uterosacral ligament suspension (54%) at 5-year follow-up ( 27 ). Use of these kits fell out of favor as the U.S. Food and Drug Administration (FDA) reported complications related to pain and mesh exposure beginning in 2006. This was further punctuated with two Public Health Notifications, the first in 2008. In 2016, transvaginal mesh kits were classified as high-risk and ultimately, in 2019 the FDA formally required that manufacturers no longer sell or distribute the product for POP repair ( 28 ). Importantly, these FDA actions applied specifically to transvaginal mesh used for POP repair and did not extend to mesh used in abdominal, laparoscopic, or robotic sacrohysteropexy procedures. While these mesh kits are no longer on the market, sheet mesh can be fashioned to perform the procedure. However, given these concerns, this procedure is practiced infrequently at present, even though it is the most heavily studied prolapse procedure with uterine preservation. In systematic review of transvaginal mesh procedures, uterine preservation was correlated with lower risk of mesh exposure when compared to hysterectomy, with an odds ratio (OR) of 0.34 [95% confidence interval (CI): 0.18–0.67] ( 5 ). Abdominal and robotic sacrohysteropexy techniques vary widely in the literature. The surgical approach utilizes the dissection techniques employed during a sacrocolpopexy to mobilize the bladder and rectum off the anterior and posterior vagina, respectively, in addition to the dissection to access the anterior longitudinal ligament of the sacrum. A fenestration also is made in the broad ligament bilaterally. Typically, a synthetic mesh is then placed on the anterior vagina and/or cervico-uterine junction and the mesh arms are passed through a window in the broad ligament to wrap the mesh arms behind the uterus. A second piece of mesh can be placed along the posterior vagina and uterus. The mesh arms are then suspended at the sacral promontory using permanent sutures, and, if desired, the peritoneum is then closed over the mesh. Multiple prospective studies have demonstrated comparable anatomic outcomes, as well as symptom control at 12-month follow-up with sacrohysteropexy when compared with hysterectomy at the time of sacrocolpopexy ( 29 - 31 ). These studies further support that there is no detriment to sexual function postoperatively when comparing the two approaches ( 32 ). A systematic review of the literature demonstrates no significant difference in resolution of subjective prolapse symptoms (89% in sacrohysteropexy compared with to 88% with hysterectomy and sacrocolpopexy, OR 0.95; 95% CI: 0.86–1.03) or objective success of treatment on pelvic exam (OR, 2.21, 95% CI: 0.33–14.67) ( 5 ).

Randomized control trials and systematic reviews have shown similar short-term anatomic success, symptom improvement, and reoperation rates compared to analogous prolapse procedures performed with concurrent hysterectomy ( 12 - 14 , 33 ). When comparing mesh-augmented repairs specifically, hysteropexy has been associated with lower risk of mesh exposure ( 5 , 34 , 35 ). This is likely related to the preservation of tissue integrity without creation of a colpotomy. These findings were confirmed in a recent meta-analysis that found no significant difference in anatomic success or reoperation rates, while demonstrating lower mesh exposure rates with uterine preservation ( 36 ). Furthermore, preservation of the uterus may support the pelvic floor and potentially play a role in sexual function. Multiple studies demonstrate equal or improved sexual outcomes following prolapse repair with uterine preservation compared to those with hysterectomy, while still reporting durability ( 30 , 32 ). While there are many purported reasons, it is difficult to delineate why sexual function may be improved with uterine preservation. One of the suggested mechanisms includes the preservation of vaginal length. Hysteropexy has shown to maintain vaginal length on postoperative POP-Q examinations, likely due to lack of colpotomy and associated vaginal cuff closure ( 5 , 12 , 14 ). While hysteropexy offers many benefits, most have been demonstrated in short-to intermediate-term studies. The evidence of durability is lacking beyond 5–10 years of follow-up, compared to the extensive long-term evidence supporting vaginal hysterectomy at the time of apical suspension ( 5 , 13 , 36 , 37 ). This lack of long-term data may preclude some providers from offering uterine preservation with confidence, in addition to the technical difficulties incurred or follow-up required by preserving the uterus. Key comparative studies evaluating hysteropexy are summarized in Table 3 .

Many studies demonstrate a great number of advantages of uterine preservation. When compared with vaginal hysterectomy, apical suspension has shown to have less intraoperative blood loss and shorter operative times. This has been described in several studies as there is decreased surgical complexity and a lack of vascular pedicles when the uterus is preserved ( 5 , 12 , 14 , 29 , 34 ). Those studies assert the shorter and less complex surgeries translate to decreased urinary symptoms, postoperative pain and faster return to normal activity. These assertions were further confirmed across multiple surgical approaches including abdominal, vaginal, and laparoscopic ( 38 , 39 ). Along with decreased morbidity, these surgeries are found to have high patient satisfaction and low subjective recurrence rates in short and intermediate length follow-up ( 5 , 40 ). While most practitioners do not recommend pregnancy following hysteropexy, there is the added benefit of maintaining fertility with these prolapse repairs. They also allow the patient to maintain the natural timing of menopause. For premenopausal patients, this should be a consideration. While ovaries may remain in place at the time of a hysterectomy with prolapse repair, this may disrupt normal blood supply to the ovaries, influencing regular function ( 5 , 33 ). Ovarian failure and earlier onset of menopause is found with higher frequency, ~15% increased risk, in patients who are post-hysterectomy with ovarian preservation ( 41 ). Given the known benefits of ovarian function in pre, and even postmenopausal women, patients should be adequately counseled regarding this risk. Hysterectomy may be indicated at the time of prolapse repair. However, in patients without uterine pathology, this may represent an unnecessary procedure. While there may be an undetected malignancy later found in uterine specimen, this has been found to be a low incidence in prior studies ( 17 ). Additionally, patients endorse psychological, sexual, and identity-related importance related to the preservation of their uterus ( 42 ).Recent data suggests up to 20% of women feel regret in the year following hysterectomy, and this regret is independent of the surgical indication ( 43 ).

By retaining the uterus, and therefore maintaining fertility, subsequent pregnancy and delivery after prolapse repair may have a further negative effect on pelvic support. Most available studies exclude women that subsequently become pregnant ( 13 , 38 , 39 ). Consequently, the majority of available data is extrapolated from case series, resulting in very little information available to counsel patients appropriately regarding durability of the repair and outcomes if pregnancy is pursued. Preserving the uterus, with or without the cervix, also sustains the continued lifetime risk of malignancy in either organ ( 15 , 17 ). This necessitates ongoing routine cervical cancer screening and evaluation of abnormal uterine bleeding, which can be made more challenging with post-surgical apical support. Patients may also be negatively impacted by continued menstruation in the setting of heavy menses. For many women, the cessation of menses may be an added benefit, even in the absence of abnormal uterine bleeding ( 5 , 42 ). While hysteropexy typically lends to less surgical complexity, this may not be the case in certain anatomic variations. Retaining the uterus can increase technical difficulty due to variations in size, shape, or contour. Anatomically, retaining the uterus may add to surgical complexity given the variations in size, shape, and contour of the organ. These may limit access for application of mesh or sutures, particularly for surgeons less experienced in hysteropexy techniques ( 5 , 37 , 38 ). Prior reviews have noted that limited surgeon training and experience with hysteropexy techniques may contribute to underutilization of uterine-preserving procedures despite increasing patient demand ( 10 ). Also, preservation of the cervix inherently results in a less favorable POP-Q C point, given the length of the cervix occupying the vagina ( 5 , 12 - 14 ). This has not been directly translated into worse subjective outcomes or re-operation rates, and so it is difficult to extrapolate how clinically meaningful this difference may be.

It is important for providers to be familiar with these approaches in an effort to not limit access to necessary prolapse repair procedures. However, it can be difficult to adequately provide patients with the knowledge necessary to choose the appropriate surgical approach due to the limitations in currently available data. Short-term data may be reassuring that uterine-preserving techniques are durable and provide sufficient symptom control. This data, however, cannot compare to the breadth and depth that exist to support more commonly performed hysterectomy-based procedures. Future research should focus on long-term outcomes including both standardized reporting and patient-reported measures. At present, the recommendation is for patients not to become pregnant after prolapse repair surgery. This is due to concerns regarding the durability of repair, as well as impact on the pregnancy and delivery. These concerns, however, are based on theoretical risk due to a paucity of data in this area beyond small case series and reports. It would be prudent to follow those patients that have become pregnant after hysteropexy to facilitate a more informed discussion regarding the implications.

This narrative review was developed through a comprehensive review of the available literature on uterine-preserving surgery for POP. Relevant publications were identified through searches of PubMed and The Ohio State University institutional library resources. Additional references were obtained from Walters & Karram Urogynecology and Reconstructive Pelvic Surgery and through review of bibliographies from key articles. Search terms included “hysteropexy”, “uterine-sparing prolapse repair”, “uterine preservation”, “pelvic organ prolapse surgery”, “sacrospinous hysteropexy”, “uterosacral hysteropexy”, “sacrohysteropexy”, and related terms. No restrictions were placed on publication year. All chosen articles were written in English. Studies were selected based on relevance to uterine-preserving prolapse repair, with emphasis placed on high-quality evidence, including randomized controlled trials, systematic reviews, meta-analyses, large observational studies, and contemporary publications. Historical studies were included when relevant to the development and evolution of specific surgical techniques. The search strategy is summarized in Table 1 . We present this article in accordance with the Narrative Review reporting checklist (available at https://gpm.amegroups.com/article/view/10.21037/gpm-2026-0017/rc ). POP, pelvic organ prolapse.

Uterine preservation is growing in popularity, and a large driver of this trend is patient preference ( 6 ). This preference may be due to emotional, sexual, cultural, or identity-related reasons ( 5 , 38 , 42 ). Shared decision making has a critical role in this discussion, and patients should be adequately counseled to understand the advantages and disadvantages to uterine-preserving POP repairs. Prior studies have demonstrated the majority of women would prefer to retain their uterus at the time of prolapse repair if the outcomes were equally efficacious ( 42 ). This preference has been found independent of age and parity ( 9 ). The data supporting hysteropexy is growing, and, in the short to intermediate-term, parallels data for analogous colpopexy techniques performed at the time of hysterectomy. Presently, there does remain a paucity of long-term follow up studies to evaluate the durability of these approaches; however, it is likely this will be remedied with longer term data as hysteropexy gains favor in the ongoing landscape. And with the current data, providers can be reassured that hysteropexy is a safe and effective option for the properly selected and counseled patient.

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