CHARLESTON, S.C. – Women with pelvic organ prolapse symptoms are more likely to favor treatment that allows for uterine preservation than treatment involving hysterectomy, according to findings from a Fellow’s Pelvic Research Network study.
Of 213 women who participated in the multicenter cross-sectional study, 36% said they would prefer uterine preservation and 20% said they would prefer hysterectomy in a scenario in which outcomes were equal, Dr. Nicole. Korbly reported at the annual meeting of the Society of Gynecologic Surgeons.
The remaining 44% had no strong preference, said Dr. Korbly of the Women and Infants’ Hospital of Rhode Island and Brown University, both in Providence, R.I.
"In a scenario in which uterine preservation was superior, the proportion of women preferring uterine preservation increased from 36% to 44%; 11% preferred hysterectomy," she said.
In a scenario in which hysterectomy was superior, the proportion preferring hysterectomy increased from 20% to 36%. Of note, in this scenario, 21% of women still preferred uterine preservation, despite its inferior efficacy, she said.
Responses in some cases differed by geographic region. For example, in the scenarios in which outcomes would be equal and in which uterine preservation would be superior, those living in the West and Northeast regions of the United States were more likely than those in the South and Midwest regions to prefer uterine preservation. The responses did not differ significantly by region in the scenario in which hysterectomy was superior.
On logistic regression analysis, those living in the South had a lower odds of preferring uterine preservation compared with those living in the Northeast (odds ratio, 0.2), Dr. Korbly noted.
Also, women with at least some college education and those who said they considered the uterus important for a sense of self had increased odds of preferring uterine preservation (OR, 3.37 and 26.3, respectively). Age, race, and ethnicity, however, were not significant predictors.
Women included in the study were patients with a mean age of 59 years who presented with prolapse symptoms at one of nine participating centers between May 2011 and October 2012. They completed a 35-item questionnaire designed to assess uterine preservation and hysterectomy preference, as well as attitudes about the potential benefits and risks of uterine preservation and knowledge about pelvic organ prolapse.
The findings are timely, given a recent increased interest in prolapse treatment options that allow for uterine preservation, Dr. Korbly said, explaining that because long-term efficacy of these treatment methods remains unclear, patient preference remains a particularly important consideration when determining the best treatment approach.
Few studies have looked at patient preference regarding uterine preservation, she said at the meeting, jointly sponsored by the American College of Surgeons.
"Well-designed clinical trials comparing uterine-preserving versus hysterectomy-based techniques for prolapse are needed to improve the decision-making process and to balance patients’ values and preferences with evidence-based treatment outcomes data," she concluded.
Dr. Korbly reported having no relevant financial disclosures.