ORIGINAL ARTICLE Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy? Themos Grigoriadis & Aikaterini Valla & Dimitrios Zacharakis & Athanasios Protopapas & Stavros Athanasiou Received: 19 June 2014 /Accepted: 13 September 2014 # The International Urogynecological Association 2014 Abstract Introduction and hypothesis Vaginal hysterectomy (VH) is a commonly performed procedure for the operative treatment of uterovaginal prolapse (UVP). The reported incidence of un- expected gynecological cancer in cases of VH for UVP ranges between 0.3 and 0.8 %. Aim of the study is to assess the incidence of malignant and premalignant gynecological his- topathological findings among women who underwent a VH for UVP and had a normal preoperative workup. Methods The histopathology reports of women who underwent VH for the treatment of UVP were retrospectively assessed. All women had a history of normal cervical smear tests and a normal preoperative transvaginal scan. Patients with a history of a premalignant or malignant gynecological pathological condition and women with abnormal uterine bleeding were excluded. Results Overall, 14 out of 333 women who underwent VH (4.2 %) were found to have abnormal histopathological find- ings of the uterus. Among them, there were 9 cases of endo- metrial hyperplasia of any type (2.7 %), 1 case of cervical cancer (0.3 %), 1 case of cervical intraepithelial neoplasia (CIN) III (0.3 %), and 3 cases of CINI (0.9 %). No cases of endometrial cancer were detected. Among women who underwent salpingo-oophorectomy (n =86) three simple se- rous cysts (3.5 %) were found, with no cases of ovarian cancer. Conclusions The incidence of unexpected premalignant or malignant gynecological pathological conditions among asymptomatic women who underwent VH, with a history of normal cervical smear tests and normal preoperative TVS, was low but not negligible. This information should be in- cluded in the preoperative counseling of women planning to undergo surgery for UVP. Keywords Vaginal hysterectomy . Uterovaginal prolapse . Risk of malignancy . Asymptomatic . Greek Abbreviations AUB Abnormal uterine bleeding BSO Bilateral salpingo-oophorectomy ET Endometrial thickness HGSIL High=grade squamous intraepithelial lesion HRT Hormone replacement therapy LGSIL Low-grade squamous intraepithelial lesion MUS Midurethral slings POP Pelvic organ prolapse PV Per vaginam SERMs Selective estrogen receptor modulators SSF Sacrospinous fixation TVS Transvaginal scan USL Uterosacral ligament UVP Uterovaginal prolapse VALS Vaginal assisted laparoscopic sacrocolpopexy VH Vaginal hysterectomy Introduction Pelvic organ prolapse (POP) is estimated to affect nearly half of all women over 50 years of age [1] and may have a negative impact on the patient’ s quality of life, daily activities, social relationships, and emotions [2]. Vaginal hysterectomy (VH) is T. Grigoriadis (*) : A. Valla : D. Zacharakis : A. Protopapas : S. Athanasiou First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, “Alexandra” Hospital, 80 Vas.Sofias Avenue, 11528 Athens, Greece e-mail: tgregos@yahoo.com Int Urogynecol J DOI 10.1007/s00192-014-2516-5