Abstract
BackgroundHysterectomy is the most common major gynaecological procedure. The aim of this study was to study vaginal, sexual and urinary symptoms following total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) in a low resource setting.MethodsA multi-centre randomized controlled trial (RCT) was conducted in two public sector hospitals in Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus> 14 weeks, previous pelvic surgery, medical illnesses which contraindicated laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery.Vaginal, sexual function and urinary symptoms were assessed by the validated translations of ICIQ-VS and ICIQ-FLUTS questionnaires. Post-operative improvement (pre-operative – post-operative) was assessed.ResultsThere was an improvement (median (IQ1-IQ3) in vaginal symptoms [TAH 6(2–8) vs 4(0–8), p < 0.001; NDVH 6(4–8.5) vs 5(0–8), p < 0.001; TLH 4(2–10.5) vs 4(0–10), p < 0.001], urinary flow symptoms [TAH 2(1–4) vs 1 (0–3), p < 0.001; NDVH 3 (2–5) vs 2 (0.5–4), p < 0.001; TLH 1(1–4) vs 1(0–3), p < 0.05], urinary voiding symptoms [TAH 0(0–0) vs 0(0–0), p = 0.20; NDVH 0(0–1) vs 0(0–0.8), p < 0.05; TLH 0(0–0) vs 0(0–0), p < 0.05] and urinary incontinence symptoms [TAH 0(0–2) vs 0(0–2), p = 0.06; NDVH 0(0–3) vs 0(0–3), p < 0.001; TLH 0(0–3) vs 0(0–2), p < 0.05] at 1-year (TAH n = 47, NDVH n = 45, TLH n = 47). There was an improvement in sexual symptoms only in the TLH group [TAH 0(0–11.5) vs 0(0–14), p = 0.08); NDVH 0(0–0) vs 0(0–0), p = 0.46; TLH 0(0–0) vs 0(0–4), p < 0.05].There was no significant difference among the three different routes in terms of vaginal symptoms score [TAH 2 (0–2), NDVH 0 (0–2), TLH 0 (0–2), p = 0.33], sexual symptoms [TAH 0 (0–0), NDVH 0 (0–0), TLH 0 (0–0), p = 0.52], urinary flow symptoms [TAH 0 (0–1), NDVH 0 (0–1), TLH 0 (0–2), p = 0.56], urinary voiding symptoms [TAH 0 (0–0), NDVH 0 (0–0), TLH 0 (0–0), p = 0.64] and urinary incontinence symptoms [TAH 0 (0–0), NDVH 0 (0–1), TLH 0 (0–1), p = 0.35] at 1-year.ConclusionsThere was a post-operative improvement in vaginal symptoms and urinary symptoms in all three groups. There was no significant difference in pelvic organ symptoms between the three routes; TAH, NDVH and TLH.Trial registrationSri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111–1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515
Highlights
Hysterectomy is the most common major gynaecological procedure
There was an improvement in sexual symptoms only in the total laparoscopic hysterectomy (TLH) group [total abdominal hysterectomy (TAH) 0(0–11.5) vs 0(0–14), p = 0.08); non-descent vaginal hysterectomy (NDVH) 0(0–0) vs 0(0–0), p = 0.46; TLH 0(0–0) vs 0(0–4), p < 0.05]
There was no significant difference among the three different routes in terms of vaginal symptoms score [TAH 2 (0–2), NDVH 0 (0–2), TLH 0 (0–2), p = 0.33], sexual symptoms [TAH 0 (0–0), NDVH 0 (0–0), TLH 0 (0–0), p = 0.52], urinary flow symptoms [TAH 0 (0–1), NDVH 0 (0–1), TLH 0 (0–2), p = 0.56], urinary voiding symptoms [TAH 0 (0–0), NDVH 0 (0–0), TLH 0 (0–0), p = 0.64] and urinary incontinence symptoms [TAH 0 (0–0), NDVH 0 (0–1), TLH 0 (0–1), p = 0.35] at 1-year
Summary
Hysterectomy is the most common major gynaecological procedure. The aim of this study was to study vaginal, sexual and urinary symptoms following total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) in a low resource setting. Hysterectomy is the most commonly performed major gynaecological operation, with up to 100,000 procedures performed annually in the United Kingdom [1, 2]. There is a knowledge gap in terms of post-hysterectomy pelvic organ function comparing the three main routes; total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) [7]. Most prospective studies show an improvement in female lower urinary tract symptoms following hysterectomy [8, 9]. There are no published studies on pelvic organ function following hysterectomy in Sri Lanka
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