[Should a hysterectomy be carried at the same time as surgery for a prolapse by vaginal route?].

Classically hysterectomy is done during vaginal surgery for prolapse. But the anatomical and physiopathological facts would be in favour of uterus or cervix preservation. Uterine preservation do not modify the anatomical results of prolapse surgery. If a mesh is used, uterine or cervix preservation reduce the chance for a vaginal erosion. The sexual consequences, aside the narrow vaginal tube, are more psychological than objectively proved. The wish of pregnancy in young patient must leads to conservative procedures with sacrofixation (Richter or Richardson) better than cervix ablation (Manchester procedure). Further uterine or ovarian pathologies are as rare as to justify hysterectomy or annexectomy, the patient must be aware of a regular gynecological exam. Hysterectomy implies more bleeding, more hospital stay, more cost. So hysterectomy during vaginal surgery for prolapse would indicate for major hysterocele or in case of concomitant uterine pathology.