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Introduction and Hypothesis <p>Concomitant hysterectomy during minimally invasive sacrocolpopexy (SCP) remains controversial because of increasing demand for uterine preservation. Beyond surgical outcomes, hysterectomy provides diagnostic value through histopathological assessment of removed uterine and cervical specimens. We evaluated the frequency of clinically significant occult pathology in women undergoing minimally invasive SCP with concomitant total hysterectomy.</p> Methods <p>We conducted a single-center retrospective cohort study of consecutive women who underwent minimally invasive SCP with concomitant total hysterectomy between June 2020 and December 2025. The primary outcome was the frequency and spectrum of histopathological diagnoses. Clinically significant pathology was defined as cervical intraepithelial neoplasia grade 3 (CIN3) or higher and/or endometrial premalignant/malignant lesions (atypical endometrial hyperplasia/endometrial intraepithelial neoplasia [AEH/EIN] or endometrial carcinoma). Secondary outcomes included mesh exposure and reoperation.</p> Results <p>A total of 196 patients were included. None of the patients reported preoperative abnormal uterine bleeding, and preoperative abnormal cervical cytology was documented in 1 patient (0.5%). Clinically significant pathology was identified in 8 put of 196 patients (4.08%), including CIN3 in 5 (2.55%), grade 1 endometrioid carcinoma in 2 (1.02%), and AEH/EIN in 1 (0.51%). All clinically significant lesions were detected in the absence of preoperative abnormal uterine bleeding. Mesh exposure occurred in 2 out of 196 (1.02%) and reoperation in 3 out of 196 (1.53%).</p> Conclusions <p>Minimally invasive sacrocolpopexy with concomitant total hysterectomy revealed a clinically meaningful rate of occult premalignant or malignant uterine and cervical pathology, despite the absence of preoperative abnormal uterine bleeding. These data should inform shared decision making in women considering abdominal mesh-based repair for uterine prolapse.</p>

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Clinically Significant Occult Uterine and Cervical Pathology in Women Undergoing Minimally Invasive Sacrocolpopexy With Concomitant Total Hysterectomy: A Retrospective Consecutive Case Series

  • 期刊论文

  • 发表日期：

    2026年6月16日

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  • Kuniaki Ota,
  • Yoshiaki Ota,
  • Keitaro Tasaka,
  • Mitsuru Shiota,
  • Koichiro Shimoya

摘要

Introduction and Hypothesis

Concomitant hysterectomy during minimally invasive sacrocolpopexy (SCP) remains controversial because of increasing demand for uterine preservation. Beyond surgical outcomes, hysterectomy provides diagnostic value through histopathological assessment of removed uterine and cervical specimens. We evaluated the frequency of clinically significant occult pathology in women undergoing minimally invasive SCP with concomitant total hysterectomy.

Methods

We conducted a single-center retrospective cohort study of consecutive women who underwent minimally invasive SCP with concomitant total hysterectomy between June 2020 and December 2025. The primary outcome was the frequency and spectrum of histopathological diagnoses. Clinically significant pathology was defined as cervical intraepithelial neoplasia grade 3 (CIN3) or higher and/or endometrial premalignant/malignant lesions (atypical endometrial hyperplasia/endometrial intraepithelial neoplasia [AEH/EIN] or endometrial carcinoma). Secondary outcomes included mesh exposure and reoperation.

Results

A total of 196 patients were included. None of the patients reported preoperative abnormal uterine bleeding, and preoperative abnormal cervical cytology was documented in 1 patient (0.5%). Clinically significant pathology was identified in 8 put of 196 patients (4.08%), including CIN3 in 5 (2.55%), grade 1 endometrioid carcinoma in 2 (1.02%), and AEH/EIN in 1 (0.51%). All clinically significant lesions were detected in the absence of preoperative abnormal uterine bleeding. Mesh exposure occurred in 2 out of 196 (1.02%) and reoperation in 3 out of 196 (1.53%).

Conclusions

Minimally invasive sacrocolpopexy with concomitant total hysterectomy revealed a clinically meaningful rate of occult premalignant or malignant uterine and cervical pathology, despite the absence of preoperative abnormal uterine bleeding. These data should inform shared decision making in women considering abdominal mesh-based repair for uterine prolapse.