Factors affecting the feasibility of bilateral salpingo-oophorectomy during vaginal hysterectomy for uterine prolapse

Background: About 15% of all hysterectomies are performed for pelvic organ prolapse, generally through the transvaginal approach. However, concomitant bilateral salpingo-oophorectomy (BSO) is not always feasible through this approach, because the adnexae are sometimes inaccessible. Aim: To identify factors affecting the feasibility of performing BSO during transvaginal hysterectomy for uterine prolapse. Methods: We reviewed charts of all women undergoing vaginal hysterectomy for uterine prolapse in our institution between December 2005 and November 2009, at which time BSO was uniformly attempted in all patients. Results: One hundred and seventy-two women who underwent vaginal hysterectomy were identified, of whom 134 (78%) underwent concomitant BSO. Women in whom BSO was feasible were younger (60.6 +/- 10.1 vs 65.6 +/- 8.6 years, P < 0.02) and had a higher prevalence of advanced prolapse, including stage IV cystocele (68% vs 38%, P = 0.01), stage III-IV rectocele (40% vs 11%, P = 0.003) and stage IV uterine prolapse (64% vs 25%, P = 0.0005). Conclusions: The feasibility of BSO was primarily dependent on the stage of pelvic organ prolapse and patients' age. Relaxation of the adnexae because of weakness of the infundibulo-pelvic ligaments may accompany severe pelvic organ prolapse and may potentially explain the feasibility of BSO in these women.