Pre-Operative Sonographic Assessment of Ovarian Location and Mobility Predicts Intra-Operative Ovarian Resectability During Vaginal Hysterectomy: A Diagnostic Accuracy Study

<b>Background/Objectives</b>: This study investigates the predictive role of pre-operative sonographic assessment of ovarian mobility in determining intra-operative ovarian resectability among patients undergoing vaginal hysterectomy for pelvic organ prolapse. <b>Methods</b>: This prospective study was conducted in a tertiary academic urogynecology center. Women with pelvic organ prolapse scheduled for vaginal hysterectomy were consecutively recruited after providing informed consent. Pre-operatively, all patients had a detailed history, pelvic examination (POP-Q), and pelvic floor ultrasound (including assessment of the mobility of both ovaries and sonographic determination of ovarian descent in relation to the pelvic ischial spines). Patients were planned for vaginal hysterectomy, anterior and posterior colporrhaphy, McCall culdoplasty, and bilateral salpingo-oophorectomy (SO), where feasible. During surgery, the location and mobility of the ovaries, as well as the presence of peri-ovarian adhesions, were recorded. Pair-to-pair comparisons between sonographic and clinical findings were performed. <b>Results</b>: From February 2023 to January 2024, 50 Caucasian adult women underwent reconstructive vaginal surgery for prolapse. Thirty-five patients underwent concomitant bilateral SO via vaginal route, seven underwent unilateral SO, and three under went salpingectomy only. ROC analysis indicated that pre-operative ultrasound assessment of ovarian mobility predicts: (1) intra-operative ovarian mobility (sensitivity 95.6%, specificity 77.8%); (2) the presence of peri-ovarian adhesions (sensitivity 46.1%, specificity 94.2%); and (3) resectability, i.e., the ability to perform SO via the vaginal route (sensitivity 96.4%, specificity 50.0%). The absence of ovarian mobility was not associated with an increased risk of intra-operative and post-operative complications. <b>Conclusions</b>: Pre-operative sonographic assessment of ovarian location and mobility can predict ovarian location and resectability during vaginal surgery with high diagnostic accuracy.