Intention Matters: Success Rate of Bilateral Oophorectomy at the Time of Vaginal Hysterectomy for Pelvic Organ Prolapse

Abstract

<h3>Study Objective</h3> To determine the incidence of successful bilateral salpingo-oophorectomy (BSO) at the time of vaginal hysterectomy (TVH) for pelvic organ prolapse (POP) and to evaluate associated factors. <h3>Design</h3> Retrospective review. <h3>Setting</h3> Tertiary center. <h3>Patients or Participants</h3> All women who underwent TVH for POP who were consented for BSO "if possible" and "including extraordinary measures" between January 2014 and December 2019. <h3>Interventions</h3> BSO at the time of TVH for POP. <h3>Measurements and Main Results</h3> A total of 454 patients underwent TVH for POP and were consented for BSO during the study period. Of these, 420 patients (92.5%) were consented for "BSO if possible" and 34 patients (7.5%) were consented for "BSO including extraordinary measures." "Success" was defined as ability to perform BSO vaginally. The success rate of BSO in all patients was 58.9% (n=267). Of the patients consented for extraordinary measures, the success rate was 91.2% (n=31). The 3 cases where BSO could not be performed vaginally were successfully completed laparoscopically. Patients who were in the "BSO if possible" group had a success rate of 55.5% (n=233). After controlling for confounders, concurrent posterior repair remained associated with successful BSO (adjOR 1.78 [95% CI=1.19-2.65]). Successful BSO was more common with a longer operative time compared to unsuccessful cases (151 min vs 134 min, p<.001). Compared to patients in the unsuccessful BSO group, the successful BSO group had a higher proportion of the following indications for BSO: a family history of ovarian cancer, personal breast cancer history or patient request for definitive removal. <h3>Conclusion</h3> When the pre-operative intention is to perform a BSO with extraordinary measures at the time of TVH for POP, the success rate is high, compared to when BSO is simply an opportunistic procedure. This suggests that the success is closely linked to the surgeon's determination to complete this procedure vaginally.