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. 2025 Jan;132(2):205-211.
doi: 10.1111/1471-0528.17974. Epub 2024 Oct 2.

Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology

Reut Rotem  1   2 , Michael O Carey  3 , Claire M McCarthy  1 , Barry A O'Reilly  1 , Yair Daykan  4   5 , Orfhlaith E O'Sullivan  1
Affiliations

Preserving Essential Skills: The Future of Vaginal Hysterectomy Training in Urogynaecology

Reut Rotem et al. BJOG. 2025 Jan.

Abstract

Objectives: This study aimed to evaluate the training and self-assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision-making, the surgical techniques employed, the training received, and the management of complications.

Design: A cross-sectional survey.

Setting: An electronic questionnaire.

Population: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members.

Methods: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries.

Main outcome measures: Demographics, surgical selection, proficiency and technique, and training methods.

Results: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two-thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10-30 cases were needed to achieve and maintain proficiency.

Conclusion: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine-sparing prolapse repairs, the decision-making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques.

Keywords: subspecialisation; surgical training; surgical volume; training requirements; vaginal hysterectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Percentage of respondents proficient in various procedures.
FIGURE 2
FIGURE 2
Percentage of respondents performing > 10 procedures per year.
FIGURE 3
FIGURE 3
Learning the technique of vaginal hysterectomy: Difficulty of each step.
See this image and copyright information in PMC

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