Search Results (51)

Apical pelvic organ prolapse (POP) is characterized by descent of the uterus or post-hysterectomy vaginal vault resulting from failure of level I pelvic support and represents a major contributor to pelvic floor dysfunction and recurrent prolapse surgery. Loss of apical support is frequently associated with anterior and posterior compartment defects, leading to vaginal bulge symptoms, pelvic pressure, urinary and bowel dysfunction, sexual dysfunction, and reduced quality of life. This narrative review summarizes current knowledge on POP, from molecular mechanisms and emerging biomarkers to contemporary surgical management, with particular emphasis on sacrocolpopexy and robotic-assisted approaches. A literature search of PubMed, Scopus, Google Scholar, and Consensus identified peer-reviewed studies published up to February 2026. Evidence demonstrates that POP has a multifactorial and polygenic background involving extracellular matrix remodeling, connective tissue integrity, smooth muscle dysfunction, and altered level of protein expression. Several candidate biomarkers, including single-nucleotide polymorphisms, circulating proteins, metabolites, and imaging-based parameters, show potential for risk prediction and earlier diagnosis, although routine clinical implementation remains limited. Sacrocolpopexy remains the gold standard for apical prolapse repair because of superior anatomical outcomes, low recurrence, and significant quality-of-life improvement. Laparoscopic and robotic-assisted sacrocolpopexy provide comparable efficacy with reduced blood loss, shorter hospitalization, and faster recovery. The objective success rate is usually over 90%. Complications are very rare and typically include mesh erosion in 2–4% of cases and the need for reoperation in 6% of cases. Our own experience shows that, for a group of surgeons, the learning curve for the laparoscopic approach reached a plateau after a total of 30 operations. Robotic platforms may facilitate complex pelvic dissection and shorten the learning curve, although higher procedural costs remain a major limitation. Full article

Objective: To assess the anatomical and clinical outcomes of a novel, mesh-free cerclage pectopexy technique that uses the round ligament for apical support following total laparoscopic hysterectomy in women with stage II uterine prolapse. Methods: This retrospective observational study included 120 women with stage II uterine prolapse who underwent total laparoscopic hysterectomy followed by laparoscopic non-mesh pectopexy between October 2023 and August 2024. In this procedure, the distal portion of each round ligament was fixed to the pectineal ligament using Ethibond sutures. Multiple plicating stitches were then placed to reinforce the ligament’s tensile strength, creating a biological suspension bridge between the pectineal ligament and the vaginal cuff. All patients were examined preoperatively and at 1, 3, 6, and 12 months postoperatively using the POP-Q system. Anatomical success was defined as an apical stage ≤ I at 12 months. Results: At the twelve-month follow-up, anatomical success was achieved in 95 percent of patients, with six cases of apical recurrence. POP-Q measurements showed significant improvement from baseline, and total vaginal length was preserved. Functional outcomes, including postoperative pain and dyspareunia, were favorable. Early complications were uncommon, and no intraoperative or mesh-related complications occurred. Conclusion: Round-ligament-based non-mesh cerclage pectopexy provides reliable apical support with minimal surgical morbidity following total laparoscopic hysterectomy. This technique appears to provide effective apical support with low surgical morbidity while avoiding synthetic mesh. Preservation of vaginal length and favorable short-term clinical outcomes were observed; however, longer-term comparative studies are required. Future prospective studies combining this procedure with other minimally invasive suspension techniques, such as McCall culdoplasty or uterosacral plication, may broaden its applicability to more advanced prolapse cases. Full article

Background: Pelvic organ prolapse (POP) is a prevalent condition that often requires surgical correction of apical support. Vaginal approaches that restore anatomy while minimizing synthetic material are of increasing clinical interest. Bilateral sacrospinous colposuspension with sling has been proposed as a minimally invasive technique; however, evidence from large clinical cohorts remains limited. Objectives: This study aimed to evaluate the anatomical, functional, and safety outcomes of this procedure in women with symptomatic advanced POP. Methods: This retrospective single-center cohort study included 235 consecutive women who underwent bilateral sacrospinous colposuspension with sling for symptomatic POP between 2018 and 2024. The primary outcomes were anatomical success (Baden stage ≤ II) and functional success (absence of vaginal bulge symptoms). Secondary outcomes included urinary, bowel, and sexual function, patient satisfaction, and postoperative complications classified according to the Clavien–Dindo system. Results: At a median follow-up of 20 months, anatomical success was achieved in 87.1% of patients and functional success in 93.6%. Significant improvements were observed in POP-Q points Ba and C (p < 0.001). Among symptomatic patients, stress urinary incontinence improved in 66%, urgency in 63%, and constipation in 71%. Overall morbidity was low (5.5%), with most complications classified as Clavien–Dindo grade I–II. Mesh extrusion occurred in 2.1% of cases, and reintervention was required in 2.1%. Functional recurrence was observed in 6.4% of patients, with 26% requiring surgical reintervention. Patient satisfaction was high (median score: 9/10). Conclusions: These findings support bilateral sacrospinous colposuspension with sling as a safe and effective vaginal approach for symptomatic advanced POP; however, the retrospective design and absence of a control group should be considered when interpreting the results. Full article

Background/Objectives: Sacrospinous ligament fixation (SSLF) is a well-established native tissue vaginal procedure for uterine/vault prolapse. Despite favorable success rates, the procedure presents technical challenges due to the deep operative field and proximity to critical neurovascular structures. To review current evidence regarding anatomical considerations, surgical technique, fixation strategies, suture materials, device-assisted methods, and perioperative complications in SSLF. Methods: A structured narrative review of the contemporary literature was conducted, focusing on comparative and systematic studies evaluating unilateral versus bilateral fixation, anterior versus posterior approach, suture type and number, and suture-capturing or anchor-based devices. Anatomical, functional, and safety outcomes were critically analyzed. Results: SSLF achieves favorable anatomical success rates with significant symptom improvement. Meticulous knowledge of sacrospinous ligament anatomy is critical to reduce bleeding and neuropathic complications. Unilateral fixation remains the most common technique, while bilateral fixation may benefit selected patients. According to the available evidence, the anterior approach may better preserve vaginal length, although it may be associated with longer operative time and short-term urinary morbidity. Absorbable and permanent sutures appear to provide comparable anatomical durability, while placement of two sutures remains the most commonly used fixation strategy. Device-assisted techniques may facilitate suture placement but require advanced anatomical expertise. Conclusions: SSLF is a safe and effective suspension procedure when individualized and meticulously performed. Further randomized studies evaluating long-term anatomical and patient-reported outcomes are warranted. Full article

Apical prolapse, a common form of Pelvic Organ Prolapse (POP), is often linked to weakened support structures such as the uterosacral (USL) and cardinal ligaments (CL), influenced by factors like vaginal childbirth, aging, and obesity. Although surgical mesh use is expected to increase, the Food and Drug Administration (FDA) banned polypropylene mesh for transvaginal anterior compartment prolapse in 2019 due to safety concerns, highlighting the need for alternatives such as biodegradable implants. This study developed four biodegradable mesh implants (square and sinusoidal geometries) mimicking the USL and CL. These were applied within a computational pelvic model to assess biomechanical behavior during the Valsalva maneuver and to explore different fixation methods (continuous, interrupted and simple stitch sutures). Baseline analysis of the healthy model established vaginal displacement under normal conditions. Without implant support, complete CL rupture increased displacement by 34%, and complete USL rupture raised displacement by 69%. Polycaprolactone implants consistently reduced anterior vaginal wall displacement in all impairment scenarios. Square implants mimicking the USL reduced displacement by up to 10% in cases of complete USL rupture with intact CL. Similarly, square implants mimicking the CL reduced displacement by up to 15% with complete CL rupture and healthy USL. Simulations with both ligaments impaired showed that USL contribute to support, while CL play a key role in stabilization. These findings demonstrate the potential of biodegradable implants to enhance POP repair. However, further studies are needed to evaluate long-term degradation and clinical applicability. Full article

Background: Relative apical sparing of longitudinal strain is widely used as a diagnostic marker of cardiac amyloidosis. However, similar deformation patterns have been reported in other cardiac diseases, raising concerns regarding disease specificity. A comprehensive multimodality synthesis of the relative apical sparing pattern (RASP) across disease entities is lacking. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Scopus, and EMBASE were searched through December 2025 for studies reporting RASP or regional longitudinal strain values allowing standardized RASP calculation. Cardiac amyloidosis and major phenocopies—including aortic stenosis, hypertrophic cardiomyopathy, hypertensive heart disease, Fabry disease, mitral valve prolapse, and other cardiomyopathies—were included. Random-effects models were used to compare cardiac amyloidosis with non-amyloid conditions using standardized mean differences (SMDs), with subgroup analyses according to imaging modality (two-dimensional speckle-tracking echocardiography [2D-STE] versus cardiac magnetic resonance feature tracking [CMR-FT]). Results: Fourteen studies (nine 2D-STE and five CMR-FT) were included in the quantitative synthesis. Overall, cardiac amyloidosis was associated with significantly higher RASP compared with non-amyloid conditions (SMD 0.676, 95% CI 0.493–0.860; p < 0.001), with substantial heterogeneity (I² = 96.9%). Modality-stratified analyses showed a very large pooled effect for 2D-STE (SMD 2.152, 95% CI 1.354–2.950; I² = 97.6%) and a moderate, homogeneous effect for CMR-FT (SMD 0.594, 95% CI 0.405–0.782; I² = 0%). Sensitivity analyses confirmed robustness. No significant publication bias was detected by Egger’s test. Conclusions: Relative apical sparing is not specific to cardiac amyloidosis but is most pronounced in this condition. Its diagnostic magnitude varies across modalities and clinical contexts, supporting a multiparametric, modality-specific interpretation. Full article

Background/Objectives: Cystocele remains a prevalent condition with high recurrence rates following conventional native tissue repair. While mesh-based techniques may reduce anatomical recurrence, they are associated with increased complications and regulatory limitations. Our study proposes a defect-oriented approach to cystocele repair to assess whether individualized surgical management based on defect type can improve outcomes, particularly recurrence rates. Methods: A single-center retrospective analysis of 317 women undergoing cystocele repair (2019–2020) was performed. Patients were classified into five groups according to defect type: lateral defect at level II, central defect at level II, apical defect, mixed apical and lateral defects at level II, and mixed apical and central defects at level II. Surgical techniques, including vaginal mesh repair, laparoscopic or pre-peritoneal Richardson repair, sacropexy, lateral suspension, and combined procedures, were tailored to the identified defect. Postoperative outcomes and recurrence rates were assessed during follow-up visits. Results: The most common defect was apical defect at level II (35.6%) followed by lateral defect (32.8%), mixed apical and lateral (17.7%), central (8.5%), and mixed apical and central (5.4%). The most frequent procedures were vaginal mesh repair (33.8%) and laparoscopic sacropexy (28.7%). In our cohort, the overall recurrence rate was 6.3%, with the highest recurrence observed in the central defect group (11.1%) and lowest in the mixed apical and lateral defect group (0%). Conclusions: A defect-oriented classification and individualized surgical approach for cystocele enables effective, durable repair with low recurrence rates. Precise identification of the anatomical defect, rather than the routine use of hysterectomy or mesh, should guide surgical planning to optimize functional and anatomical outcomes. Full article

Background/Objectives: Durable apical support after hysterectomy is crucial to prevent subsequent vaginal vault prolapse. Abdominal sacrocolpopexy remains the gold standard but carries risks of visceral injury and wound morbidity. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) approach provides a scarless, minimally invasive alternative, but data on vNOTES-assisted sacrocolpopexy (vNOTES-SC) performed concurrently with hysterectomy remain limited. Methods: A retrospective cohort of 30 women with stage II uterine prolapse underwent concomitant hysterectomy and vNOTES-assisted sacrocolpopexy between January 2023 and January 2024. Anatomical outcomes were evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) system preoperatively and at 12 months postoperatively. The primary endpoint was anatomical success (C ≤ −1 cm); the secondary endpoint used the IUGA criterion (C < −TVL/2). Complications were graded using the Clavien–Dindo classification. Statistical analyses included Wilcoxon signed-rank tests, effect-size estimation, ROC analysis, logistic regression, and Spearman correlation. Results: Mean operative time was 100.2 ± 11.7 min, mean blood loss 155.3 ± 74.8 mL, and mean hospital stay 1.5 ± 0.7 days. Significant improvements were seen in Aa, Ba, C, and Bp points (p < 0.001). Anatomical success (C ≤ −1 cm) was achieved in 73.3% and clinical success in 93.3% of patients. Two patients exhibited anatomical recurrence (6.7%), whereas one patient reported symptomatic recurrence (3.3%). Using the IUGA definition, anatomical success increased to 83.3%. The difference between strict success (C ≤ −1 cm) and IUGA success (C < −TVL/2) reflects definitional sensitivity, particularly in post-hysterectomy vaginal length. All complications were minor (Grade I–II). ROC analysis showed age as a weak predictor (AUC = 0.67). Effect sizes were large for apical and anterior compartments (Cohen’s d = 1.84 for C-point). Conclusions: Concomitant hysterectomy with vNOTES-assisted sacrocolpopexy is a feasible, safe, and effective scarless approach for apical support restoration. The procedure provides significant anatomical correction and rapid recovery with low morbidity. Patients had symptomatic stage II prolapse with risk factors for early failure after native-tissue repair, supporting the selection of sacrocolpopexy for durable apical support. Larger prospective trials are needed to confirm long-term efficacy and functional outcomes. Full article

Urogenital prolapse (UP), a manifestation of pelvic organ prolapse (POP), is prevalent and burdensome, impairing urinary, bowel, sexual and psychosocial health. This review synthesizes evidence on epidemiology, mechanisms, clinical evaluation and treatment, with an emphasis on mesh use. POP results from failure of muscular and fascial support, most consistently associated with childbirth and aging; imaging links levator ani avulsion and hiatal overstretching to onset and recurrence. Diagnosis is chiefly clinical, using standardized pelvic examination, with selective adjuncts such as urodynamics, cystoscopy, pelvic floor ultrasound and defecography. Conservative care includes education, lifestyle measures, pelvic floor muscle training and pessaries. Surgery is considered for bothersome prolapse and individualized by compartment, symptoms, sexual goals, comorbidities and preference. Options span native-tissue vaginal repairs with apical suspension, obliterative procedures for non-sexually active patients and sacrocolpopexy. Sacrocolpopexy remains the durability benchmark for apical support but carries mesh-related risks that accumulate over time. Regulatory scrutiny followed rising complications, culminating in withdrawal of transvaginal mesh kits for anterior prolapse, while mesh for sacrocolpopexy persists. Quality-of-life outcomes are central to assessment. Pain after mesh may reflect placement or evolution (erosion, proximity) or persist despite normal findings, implicating neuroplastic mechanisms. Individualized, shared decision-making is essential to balance durability, safety and function. Full article

Background/Objectives: Pelvic organ prolapse (POP) surgery can lead to postoperative stress urinary incontinence (SUI) in previously continent women, termed de novo SUI. This study assessed the incidence and risk factors of de novo SUI after apical POP repair, hypothesizing that reduced bladder neck elasticity—particularly within the zone of critical elasticity (ZCE) described by the Integral Theory—contributes to its development. Methods: A retrospective single-center analysis was performed in 206 postmenopausal women (≥60 years) who underwent apical POP surgery without concomitant anti-incontinence procedures. Patients were classified by surgical approach as laparoscopic sacrocolpopexy (SCP) or vaginal native tissue repair. Results: The overall incidence of de novo SUI was 8.7%. Laparoscopic SCP for vaginal vault prolapse was significantly associated with a higher risk of postoperative SUI (OR 10.37, 95% CI 2.70–39.79, p = 0.001), whereas other procedures showed no significant association. Neither prior hysterectomy nor cystocele stage was an independent predictor of de novo SUI. Conclusions: These results suggest that surgical alteration of the ZCE—particularly excessive tension or reduced elasticity near the bladder neck—may impair urethral closure. Therefore, preserving ZCE integrity and carefully adjusting mesh tension during apical POP repair may reduce the risk of de novo SUI. Full article

Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to a lack of knowledge, misunderstandings about the condition, and obstacles to accessing healthcare. This narrative review explores the progression of POP management towards a focus on patient-centered care, highlighting the importance of personalized treatment strategies that prioritize patient-reported outcomes (PROs) over solely anatomical factors. The approach to treatment has transitioned from being centered on anatomy to focusing on the patient, emphasizing the relief of symptoms and enhancement in QoL. Existing research indicates that monitoring without intervention is advisable for asymptomatic patients, as long-term studies have revealed that up to 40% of women experience stable or improved prolapse over a period up to 60 months. Pessary treatment has a fitting success rate above 90% and a treatment persistence rate of 60%, providing an effective non-surgical option for management. The approach to selecting surgical treatments has progressed to prioritize sufficient apical support as a key factor for achieving lasting results. For primary POP, native tissue repair (NTR) is now recommended as the first-line surgical option. Mesh-augmented repairs are used only in certain high-risk situations, whereas sacrocolpopexy offers the best anatomical stability for particular cases, such as those involving post-hysterectomy prolapse and recurrences. Contemporary POP management involves personalized, patient-focused decision-making that emphasizes addressing symptom severity and functional objectives rather than solely aiming for anatomical precision. The evidence suggests that NTR should be the primary surgical approach, while other procedures should be reserved for specially chosen patients. Success should primarily be evaluated based on PROs instead of anatomical factors, ensuring that treatments align with each patient’s preferences and expectations while reducing complications. Full article

Background: Pelvic organ prolapse (POP) significantly impairs patients’ quality of life, especially in urinary, bowel, and sexual domains. While laparoscopic sacrocolpopexy (LS) is the current gold standard for apical prolapse repair, it is associated with certain complications. Laparoscopic pectopexy (LP), a newer technique utilizing the iliopectineal ligament for apical suspension, may offer improved outcomes with fewer adverse effects. This scoping review aimed to evaluate patient-reported outcomes (PROs) and quality of life (QoL) following LP and compare its effectiveness to other established surgical approaches. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches of PubMed, Scopus, and Web of Science databases were performed through June 2025. Eligible studies included randomized controlled trials, prospective and retrospective cohorts, and case series that reported PROs following LP. Data on validated QoL tools (e.g., P-QOL, PFDI-20, PFIQ-7, FSFI, PISQ-12), surgical technique, and follow-up duration were extracted. Due to heterogeneity in the study design and outcomes, findings were synthesized qualitatively. Results: Thirteen studies including a total of 742 patients met the inclusion criteria. Across all included studies, LP was associated with significant improvements in QoL metrics, including urinary and sexual function, and overall patient satisfaction. Tools such as PFDI-20, FSFI, PISQ-12, and PGI-I consistently showed postoperative improvement (p < 0.05). Comparative studies demonstrated that the outcomes for LP were similar or superior to those of sacrocolpopexy, sacrospinous fixation, or sacrohysteropexy, particularly regarding sexual function. Conclusions: LP is an effective surgical alternative for apical POP repair, offering significant improvements in patient-reported quality of life and functional outcomes. Its favorable safety profile and comparable efficacy to traditional methods make it a compelling option, particularly for patients with contraindications to sacral dissection. Findings are limited by small and heterogeneous studies, short follow-up, and potential publication and language biases. Further prospective studies with long-term follow-up periods are necessary to confirm these findings and refine patient selection criteria. Full article

Background: Laparoscopic sacropexy (SP) is widely recognized as the gold standard for addressing apical pelvic organ prolapse. Nonetheless, alternative laparoscopic procedures, such as pectopexy (PP) and Dubuisson’s laparoscopic lateral suspension (LLS), have gained traction due to their relative technical simplicity. Objective: This study aims to assess both the preoperative characteristics and surgical outcomes in a cohort-based comparative study of three minimally invasive apical prolapse surgeries. Methods: We conducted a prospective, single-center study involving patients treated laparoscopically for apical prolapse. The surgical approaches compared include: sacropexy (SP); laparoscopic lateral suspension following Dubuisson’s technique (LLS), and pectopexy (PP). Results: A total of 180 patients underwent surgery: 115 with SP, 33 with LLS, and 32 with PP. While some differences were observed in patient profiles—such as a lower average BMI and more advanced prolapse stages (III and IV) in the SP group—the rates of surgical failure (evaluated through apical recurrence, need for reintervention, pessary use, and persistent symptoms) did not differ statistically between groups. In terms of anatomical outcomes, only the total vaginal length (TVL) was notably longer in the SP group. A clinically important finding was the substantially reduced operative time with the alternative methods, particularly LLS, which took less than half the duration required for SP, without any increase in intraoperative complication rates. Conclusions: Further research, particularly well-designed randomized multicenter trials, is essential to establish the relative efficacy of the alternative approaches (LLS and PP) compared with the current gold standard, sacropexy. Full article

Background/Objectives: De novo stress urinary incontinence (SUI) can develop postoperatively in patients without prior symptoms, and can persist beyond 6 months, posing clinical challenges. This study aimed to identify predictors of persistent de novo SUI after transvaginal mesh (TVM) surgery and to evaluate management strategies. Methods: A retrospective review of 817 women with anterior and apical pelvic organ prolapse (POP) (stage II–IV) who underwent TVM surgery from 2013 to 2021 was conducted. Fifty patients developed de novo SUI postoperatively. Assessments included urodynamic studies, validated symptom questionnaires, and POP quantification (POP-Q) staging. Logistic regression analysis was used to identify predictors of persistent symptoms. Results: Spontaneous resolution occurred in 30% (15/50) of participants within six months, while 70% (35/50) had persistent SUI. Concomitant posterior mesh repair was more frequent in the persistent group compared to the self-limiting group (29% vs. 7%), and was significantly associated with symptom persistence (OR 5.6, 95% CI, 0.65–48.4; p = 0.03, chi-square test). During conservative management with observation alone, 30% (15/50) experienced spontaneous resolution within 6 months, while 70% (35/50) had persistent symptoms. Among those with persistent symptoms, 56% required no further treatment, 10% improved with vaginal laser therapy, and 4% underwent sling surgery. Conclusions: Conservative management remains critical in the early postoperative period, given the high rate of spontaneous symptom resolution. For persistent cases, minimally invasive options such as vaginal laser therapy may be beneficial. Notably, only 4% required anti-incontinence surgery. Full article

Background/Objectives: Pelvic floor disorders (PFDs) have multifactorial etiology. This makes treatment challenging and often unsatisfactory. This project introduces robust data on risk factors for PFDs and explores opportunities for their prevention, focusing on previous gynecological surgical interventions. Methods: We conducted a retrospective analytical cohort study analyzing demographic and clinical data from 832 consecutive patients who underwent pelvic organ prolapse (POP) surgery at a teaching hospital affiliated with the University of Cologne between 2010 and 2019. Patient characteristics—including age, body mass index (BMI), parity, mode of delivery, and symptoms—were collected from medical records. Associations between patient factors and surgical history were assessed using Kendall’s Tau (KT) for correlations and relative risks (RRs) with 95% confidence intervals (CIs) to evaluate the impact of previous hysterectomies and pelvic surgeries on PFD. Results: First vaginal delivery and age were the strongest factors associated with PFD. BMI had a smaller impact, and multiple vaginal deliveries did not significantly influence apical (KT 0.037), posterior (KT 0.007), anterior midline (KT 0.015), or lateral defects (KT 0.015). Cesarean section was protective. Subtotal hysterectomy showed no significant association with PFD. Total hysterectomy was strongly associated with posterior defects (RR 4.750, 95% CI: 1.871–12.059) and anterior midline defects (RR 1.645, 95% CI: 0.654–4.139). Recurrent urinary infections were associated with abdominal colposuspension (RR 4.485, 95% CI: 1.12–18.03). Dyspareunia occurred more frequently after vaginal (RR 3.971, 95% CI: 0.78–20.14) and abdominal hysterectomy (RR 1.620, 95% CI: 0.32–8.15). Vaginal hysterectomy was linked to fecal incontinence (RR 5.559, 95% CI: 1.17–26.30), MUI (RR 2.156, 95% CI: 1.09–4.23), and UUI (RR 4.226, 95% CI: 1.82–6.85). Conclusions: The factors identified as influencing (PFD) offer a solid foundation for evidence-based patient counseling within our population. Our large dataset confirmed key risk factors, notably childbirth and advancing age. However, the influence of BMI on symptoms and anatomical defects appears to be less significant than previously assumed. Subtotal hysterectomy was not associated with new PFD in our cohort and may represent a viable option when hysterectomy is indicated, though further studies are needed to confirm this potential advantage. Full article