{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:58:22Z","timestamp":1790744302299,"version":"4.1.0"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and Hypothesis<\/jats:title>\n                    <jats:p>Uterus preservation is increasingly used for uterovaginal prolapse (U-POP) repair despite ongoing concerns regarding future uterine, cervical, and adnexal pathology. We evaluated incidental pathology rates, associated risk factors, and created global consensus statements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for studies including women undergoing U-POP surgery with uterus present in\u2009\u2265\u200950% and cohorts of\u2009\u2265\u200930 participants exploring risk factors for pathology. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions and evidence certainty using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Meta-analyses were performed on the proportions of incidental pathology. Findings informed a modified Delphi process resulting in consensus statements on best practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 4,148 screened records, 33 studies met the eligibility criteria. Meta-analysis showed that the pooled prevalence of malignant pathology at the time of surgery was 0.6% (95% CI 0.0\u20131.0%; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200993.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), ranging from 0% to 3.2%. Most studies excluded patients with known malignancy risk factors. Among six uterus-preserving studies, meta-analysis showed that malignancy rates did not differ between screened and unscreened populations (0.50% vs 0.58%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.88). Six retrospective cohort studies identified risk factors for incidental endometrial malignancy: older age, higher uterine weight, and abnormal preoperative ultrasound each emerged in two studies, with no factor consistent across them. Three consensus statements were supported by high-quality evidence and three were accepted through Delphi consensus.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Incidental pathology in U-POP surgery is rare (&lt;\u20091%), and no single risk factor reliably predicts malignancy. Preoperative screening does not show significant reduced malignancy rates in uterus-preserving surgery. Global consensus statements offer guidance on when hysterectomy should be considered over uterus preservation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-026-06849-4","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:17:56Z","timestamp":1790695076000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient Risk Factors for Incidental Pathology After Uterovaginal Surgery for Apical Prolapse: Systematic Review and Global Expert Consensus Statements"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2847-5249","authenticated-orcid":false,"given":"Marie E.","family":"Sullivan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9109-7332","authenticated-orcid":false,"given":"Agustina","family":"Vendramini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5232-3619","authenticated-orcid":false,"given":"Laura","family":"Cattani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1194-0842","authenticated-orcid":false,"given":"Roxana","family":"Geoffrion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1827-0020","authenticated-orcid":false,"given":"Ann-Sophie","family":"Page","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2538-6689","authenticated-orcid":false,"given":"Vinita","family":"Gottipati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4788-029X","authenticated-orcid":false,"given":"Mackenzie","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0922-5727","authenticated-orcid":false,"given":"Kaidi","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4681-4304","authenticated-orcid":false,"given":"Kirsten","family":"Kluivers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-5695","authenticated-orcid":false,"given":"Ankita","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2237-6094","authenticated-orcid":false,"given":"Catherine A.","family":"Matthews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1012-7713","authenticated-orcid":false,"given":"John O. 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