Management of the Uterus During Prolapse Surgery: Hysterectomy vs Uterine Preservation

Abstract Purpose of Review Pelvic organ prolapse (POP) affects nearly 40% of women, with approximately 13% requiring surgery. Historically, hysterectomy was standard in prolapse repair, but evolving evidence has prompted a shift toward uterine preservation. This review examines whether uterine-preserving prolapse procedures (UPPS) offer outcomes comparable to hysterectomy-based approaches and explores factors influencing surgical decisions, including patient preferences and surgical innovations. Recent Findings Recent randomized trials and meta-analyses are non-inferior to hysterectomy based surgeries in terms of anatomical success, recurrence, and patient satisfaction. Advantages include shorter operative time, less blood loss, fertility preservation, and psychological benefits. However, hysterectomy remains necessary for malignancy, abnormal bleeding, or anatomic distortion. Summary Uterine preservation is a safe, effective, and increasingly preferred option in the management of POP. For appropriately selected patients, it offers comparable outcomes to hysterectomy while honoring reproductive goals and self-identity. Shared decision-making remains critical, balancing patient values with individualized surgical planning.