Role of salpingectomy at the time of urogynecologic surgery

Megan S. Bradley, Anthony G. Visco

This article reviews the current literature about prophylactic bilateral salpingectomy and provides guidelines for clinicians in regard to the inclusion of salpingectomy at the time of urogynecologic surgery. After the Nurses' Health Study showed that all-cause mortality was increased in women undergoing oophorectomy at the time of hysterectomy for benign indications, there was a shift in focus toward ovarian conservation at the time of gynecologic surgery. As there has been continued interest in the fallopian tube as the origin of ovarian cancer, a move toward prophylactic salpingectomy has occurred. This strategy has become widely accepted in high-risk women, but is not universal in either premenopausal or postmenopausal women who are primarily served by the urogynecologic community. Current literature supports that, if easily accessible, the fallopian tubes should be removed at the time of urogynecologic surgery. In premenopausal women, salpingectomy does not likely affect ovarian reserve, but this possibility should be discussed with patients. If inaccessible (i.e., at the time of a midurethral sling), there should not be additional surgery performed to access the fallopian tubes. In addition, the pathologic evaluation of the fallopian tubes should include complete examination of the fimbriae and a representative section of the nonfimbriated portion.