Impact of Vaginal Cuff Closure Technique on Postoperative Vaginal Length and Sexual Function: A Prospective Randomized Study

Background: Total abdominal hysterectomy is most common performed gynaecological operation. There is no standard recommendation or guidelines regarding management of vaginal cuff. This study aimed to determine the advantages and disadvantages of vaginal transection versus vaginal entry technique following elective abdominal hysterectomies for benign lesions. Methodology: This is a comparative study involving 180 women undergoing elective hysterectomy in Sparsh hospital, from 10 Jan 2015 to 10 Jan 2020. Patient was randomized to either transactional vaginal or vagina entry technique of cuff closure. In this, we compare Operating time, length of hospital stays, estimated blood loss, post operative discharge. Vaginal length, vaginal cuff infection and granulation after 6 weeks follow up time. A prospective study on all hysterectomies performed by the single senior surgeon at Sparsh hospital in order to eliminate possible differences in surgical techniques and abilities. Result: We found in this study that operating time, blood loss, post operative discharge from vault is less in transection technique of vaginal cuff closure in comparison to vaginal entry technique. Febrile complain is more in vaginal entry cuff group patients. Hospital stay is long in vaginal entry technique patients. There is no difference in post operative vaginal length in both the techniques. Transection technique is easy to perform. Conclusion: Transection cuff closure technique is better than vaginal entry technique.

Comparison of 2 Methods of Vaginal Cuff Closure at Laparoscopic Hysterectomy and Their Effect on Female Sexual Function and Vaginal Length: A Randomized Clinical Study

McCall Culdoplasty vs. Sacrospinous Ligament Fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women

The effect of hysterectomy on vesicourethral and sexual functions remains controversial. The primary objective of this study was to compare the effects of a laparoscopic hysterectomy and a total abdominal hysterectomy on lower urinary tract function. The secondary aims were to compare the two surgeries in terms of postoperative vaginal length and dyspareunia. This was a prospective randomized clinical study in which 292 women were assigned to either the laparoscopic hysterectomy (n = 146) or total abdominal hysterectomy (n = 146) groups. The vaginal length and urodynamic measurements were taken, and the patients were asked to grade the presence and severity of dyspareunia using a visual analog scale 3 weeks before and 12 weeks after the surgery. The relationship between the postoperative vaginal length and the incidence of dyspareunia was evaluated. The urodynamic procedures used included uroflowmetry and voiding cystometry to record the maximum flow rate (Q-max) and to assess the bladder capacity. The preoperative vaginal length was similar between the groups, whereas the postoperative vaginal length was significantly longer in the laparoscopic hysterectomy group. When the 15 patients who developed postoperative dyspareunia were evaluated, no differences in the postoperative vaginal length were seen, but a significant difference in the change in the length of the vagina was found when compared with the other patients. No significant difference was found with regard to pre- and postoperative Q-max, bladder capacity, and change in bladder capacity between the study groups. The change in the length of the vagina was much more remarkable after total abdominal hysterectomy, compared with laparoscopic hysterectomy. It seems that the Q-max and the bladder capacity increase after hysterectomies, regardless of the surgical type. Further prospective randomized comparative studies are warranted to ascertain whether laparoscopic hysterectomies cause less damage to the pelvic floor, compared with abdominal hysterectomies.

BackgroundThe aim of this study was to compare the outcomes of modified Bakay technique (MT) to standard colpotomy (ST) and cuff closure in total laparoscopic hysterectomy (TLH).MethodsThis two-centre, randomized-controlled study included a total of 160 patients who were scheduled for TLH for benign diseases (ClinicalTrials.gov Identifier is NCT05080114 and the first posted date was 15/10/2021). The patients were allocated into two groups by a computer-based randomization programme as ST group and MT group. Total operative time, cuff closure time, length of hospital stay, intra- and postoperative complications according to the Clavien-Dindo classification, pre- and postoperative vaginal length, and patient satisfaction according to the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed.ResultsSeventy-seven patients in the ST group and 80 patients in the MT group underwent TLH. The total operative time was significantly shorter in the MT compared to the ST (55.5 vs. 59 min, respectively; p = 0.001). The median total operative time for colpotomy, extraction of uterus, and vaginal cuff closure steps was 9 (range 6–12 in MT vs. 6 to 11 in ST) min in both groups. The median hospital stay was 2 (range 1–4) days in both groups. Intraoperative blood loss was not significantly different between the groups (90 mL in ST vs. 80 mL in MT; p = 0.456). The mean uterine weight for the ST group and MT group was comparable (258.6 ± 88.6 g vs. 232.9 ± 102.5 g, respectively; p = 0.107). The preoperative vaginal length was not significantly different between the groups (p = 0.502). The median postoperative vaginal length was significantly higher in the MT group compared to the ST group on Day 90 (8 cm vs. 7,5 cm, respectively; p = 0.001). The PGI-I questionnaire score on Day 90 postoperatively was 2 (range 1–5) in both groups (p = 0.636). The complication rates were similar between the groups (p = 0.230).ConclusionThe MT can be safely performed in most of the cases requiring TLH with the advantages of vaginal cuff closure before the alteration of pelvic anatomy, support to primary healing of the vaginal cuff, and routine concomitant apical support.

The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy

A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.

Vaginal agenesis is one of the most common causes of primary amenorrhea. Creating a vagina that allows coitus is a necessary procedure for the psychological and social well-being of these patients. For this purpose, McIndoe method is the most frequently used method. Various materials are used as grafts in this surgery. In this study, the aim was to compare the amnion and skin grafts that are used in the McIndoe method. Between 2011 and 2021, 12 patients were operated on using the McIndoe method. Chromosomal analysis, operation times, preoperative and postoperative vaginal lengths and complications were evaluated. Sexual function of the patients was evaluated with the Female Sexual Function Index (FSFI) questionnaire. Skin was used in seven patients and amnion was used in five patients. Chromosomal anomaly was detected in two patients. Operation times were significantly shorter in the group with amnion grafts. Postoperative tissue infection developed in one patient. In the evaluation at the end of the first year, it was observed that vaginal stenosis developed in two patients in whom amnion was used. Vaginal lengths were longer in skin group (8.7 ± 1.1 cm vs 5.4 ± 2.5 cm). Nine patients had active sex life. Female Sexual Function Index score was 30.3 ± 5.8 in skin group n = 6 and 27.9 ± 5.5 in amnion group n = 3 which was evaluated as normal. The most used method for vaginoplasty is McIndoe. There is no consensus on the ideal material for grafting. Regardless of which graft is used, regular usage of the dilator is the cornerstone of this procedure.

Objective To investigate the quality of marriage and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension. Methods Case-control and questionnaire-based methods were used in this study. Forty patients of early-stage (Ⅰb 1~Ⅰb2) cervical cancer who had undergone vaginal extension following classic radical hysterectomy were included in the observation group, while 40 patients with matching factors and radical hysterectomy only during the same period were included in the control group. The quality of marriage and sexual function were compared with OLSON marriage prolapse and incontinence sexual function questionnaire Shon Fonn (PISQ-12). Results The operation time and postoperative vaginal length in the observation group were higher than those in the control group (P<0.05 or P<0.01). The emotional, physical, and total scores during postoperation were lower than those during preoperation (P<0.01). The emotional, physical, and total scores in the control group were lower than those in the observation group (P<0.01). The marital satisfaction, husband and wife communication, conflict resolution methods, extracurricular activities and sex scores in the observation group were higher than those in the control group (P<0.05 or P<0.01). Conclusions Patients with peritoneovaginoplasty following radical hysterectomy had much longer vagina and less self-perceived short vagina. Vaginal extension following radical hysterectomy does not worsen the pelvic floor symptoms. Key words: Hysterectomy; Vagina/SU; Uterine cervical neoplasms/SU; Marriage; Quality of life; Sexual behavior

To investigate the effect of vaginal cuff closure technique in laparoscopic hysterectomy on vaginal length and female sexual functions. This study was conducted at a tertiary research hospital. Women who underwent laparoscopic hysterectomy were included and classified according to vaginal cuff closure technique as laparoscopic (n = 75) and vaginal route (n = 25). Vaginal lengths were measured preoperatively and at 6th month postoperatively. Golombok-Rust Inventory of Sexual Satisfaction (GRISS) was used to evaluate female sexual functions. SPSS was used for statistical analysis and the level of significance was p = 0.05. Preoperative GRISS scores and vaginal lengths were similar in two groups. The shortening of vaginal length and the worsening of GRISS scores were more prominent in vaginal cuff closure group (p = 0.002, p < 0.001). The alteration in vaginal length was positively correlated with the alteration in GRISS score in vaginal and laparoscopic route groups (r = 0.800, p < 0.001; r = 0.680, p < 0.001). The risk of female sexual dysfunction increases 69.88 fold for each 1 cm shortening of vaginal length (p = 0.039). Discriminative value of postoperative vaginal length for female sexual dysfunction in patients who underwent laparoscopic hysterectomy was investigated and a cut-off value of 7.4 cm (p < 0.001) was found. Laparoscopic route instead of vaginal route in laparoscopic hysterectomy is preferable to preserve a better vaginal length, which may be an important factor for female sexual functions.

Vaginal length and incidence of dyspareunia after total abdominal versus vaginal hysterectomy

Laparoscopic Modified Richardson Angle Inseam Vaginal Cuff Closure

The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy.

Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study

To compare vaginal length and sexual function after total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH), and vaginal hysterectomy (VH). The present cross-sectional study at a single center in Turkey compared vaginal length and sexual function among women who received TLH, TAH, VH, or no surgery (groups 1, 2, 3, and 0, respectively) between January 2011 and April 2014. All women underwent hysterectomy for benign reasons at least 3months before the study and were sexually active. Vaginal length was measured between the hymenal ring and vaginal apex. Sexual function was assessed via the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, short form (PISQ-12). Vaginal length in groups 0, 1, 2, and 3 was 10.9±1.5, 8.9±1.4, 8.5±1.2, and 8.1±0.7cm, respectively; it was significantly longer in the control group (P<0.001), and significantly shorter in group 3 than in group 1 (P=0.03). The mean PISQ-12 score in groups 0, 1, 2, and 3 was 18.6±5.2, 12.9±3.0, 13.8±4.4, and 11.5±4.4, respectively, and was significantly higher in group 0 (P<0.001). Total hysterectomy shortened vaginal length and compromised sexual function regardless of the technique used.