Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.
OBJECTIVE
The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation.


METHODS
This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression.


RESULTS
Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation.


CONCLUSIONS
A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for a sense of self were predictors of preference for uterine preservation.
Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI. Electronic address: nbkorbly@gmail.com.
Nicole B
NB
Korbly
Nadine C
NC
Kassis
Meadow M
MM
Good
Monica L
ML
Richardson
Nicole M
NM
Book
Sallis
S
Yip
Docile
D
Saguan
Carey
C
Gross
Janelle
J
Evans
Vrishali V
VV
Lopes
Heidi S
HS
Harvie
Vivian W
VW
Sung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005843:Geography; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D059351:Organ Sparing Treatments / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D056887:Pelvic Organ Prolapse / Q000523:psychology / Q000601:surgery; D012649:Self Concept; D011795:Surveys and Questionnaires; D014481:United States; D014596:Uterine Prolapse / Q000523:psychology / Q000601:surgery*
hysterectomy; patient preference; prolapse; uterine preservation