In the footsteps of Bonney and Nichols: hysterectomy during surgical repair of pelvic organ prolapse

Based on the available urogynecological literature, the role of hysterectomy in the surgical strategy of pelvic organ prolapse (POP) repair remains controversial. Currently, there are no data to favor either the removal or preservation of the uterus in women with POP. The findings that hysterectomy may contribute to a higher success rate and to the development of urinary incontinence and/or female sexual dysfunction are not supported by evidence. It is not clear why both hysteropexy was sometimes performed in the presence of overt uterine prolapse and/or concomitant vaginal hysterectomy was often included in vaginal prolapse repair in the absence of uterine prolapse. In our opinion, it makes both anatomical and clinical sense to remove the uterus only (and always) when the uterus is one of the pelvic organs directly involved in the prolapse, but to preserve and suspend the uterus otherwise.