Background:Given the prevalence of women seeking surgical treatment for pelvic organ
prolapse (POP), there is a need to understand women’s decision-making
regarding uterine-preserving versus hysterectomy-based surgeries.
Historically, hysterectomy-based surgeries have been the preferred treatment
for pelvic organ prolapse; however, contemporary evidence supports
uterine-preserving surgeries as equivalent. At present, the lack of
information available to the general public and limited options presented at
surgical consultation for pelvic organ prolapse may hinder women’s autonomy
as they navigate surgical treatment.Objectives:To examine the factors affecting women’s decision-making processes regarding
uterine-preserving or hysterectomy-based surgery for pelvic organ
prolapse.Design:This is a qualitative study.Methods:We conducted semi-structured, qualitative interviews with women seeking
surgery for pelvic organ prolapse to explore the factors affecting women’s
decision-making between hysterectomy-based and uterine-preserving
surgeries.Results:Women (n = 26) used clinical and personal factors to determine which surgery
was best. Women noted that the lack of evidence (clinical and/or anecdotal)
available to them hindered their decision-making, causing them to rely more
on their own interpretations of the evidence, what they perceived to be
“normal,” and what their surgeon recommended. Even with standardized
discussion regarding the existing clinical equipoise between surgeries at
the clinical consultation, some women still had misperceptions that
hysterectomy-based surgery would convey the lowest risk of prolapse
recurrence and be best for severe prolapse.Conclusion:There is a need for more transparency in discussions about prolapse and the
factors affecting women’s decision-making for surgical repair of pelvic
organ prolapse. Clinicians should be prepared to offer the option of
hysterectomy-based or uterine-preserving surgeries and to clearly explain
the clinical equipoise between these procedures.