Effect Of Hysterectomy Research Articles

ASSOCIATION OF HYSTERECTOMY WITH HYPERTENSION INCIDENCE IN KOREAN WOMEN: A NATIONWIDE COHORT STUDY

Objective: Although several observational studies have reported a higher risk of cardiovascular events in women who underwent hysterectomy, the underlying mechanism is unclear, and limited data exist regarding the effect of hysterectomy on the incidence of hypertension. We sought to evaluate the association between hysterectomy and the development of hypertension in Korean women aged 40–59 years. Design and method: In this Korean nationwide cohort study, 803,255 women aged 40-59 years were selected for analysis from January 1, 2002, to December 31, 2011. In total, 13,650 pairs were included in the hysterectomy and non-hysterectomy groups after 1:1 propensity score matching for age at 5-year intervals, year of inclusion, socioeconomic status, body mass index, residential region, Charlson comorbidity index, menarcheal age, menopause, diabetes, dyslipidemia, physical activity, smoking history, alcohol consumption, menopausal hormone therapy before inclusion, adnexal surgery history, uterine leiomyoma, and endometriosis. The primary outcome was the development of hypertension during follow-up. The participants were followed-up until December 31, 2020. Data analysis was performed from July 16, 2022 to January 07, 2023. Results: During median follow-up periods (10.6 years [IQR 9.2-12.6]; 10.9 years [IQR 9.2-12.7]), the incidence of hypertension was 22/1,000 person-years and 20/1,000 person-years for the hysterectomy and non-hysterectomy groups, respectively. The hysterectomy group had a significantly higher rate of development of hypertension than that of the non-hysterectomy group (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.05-1.17). The risk was prominent in women whose hemoglobin level increased by >2g/dL post-hysterectomy. In women who had an adnexa-sparing hysterectomy, the incidence of hypertension was higher (HR, 1.15; 95% CI 1.08-1.23, P <0.001) than that in the non-hysterectomy group. Conclusions: In this nationwide cohort study of Korean women revealed that hysterectomy was independently associated with an increased risk of hypertension among women aged 40 to 59. In particular, this risk elevation was prominent when the hemoglobin level increased by >2g/dL after hysterectomy, suggesting that hemorheologic changes following hysterectomy may have an impact on the occurrence of hypertension.

Pengaruh Tindakan Histerektomi terhadap Kualitas Kepuasan Seksual pada Pasien Plasenta Akreta di Indonesia (Literature review)

Placenta accreta is a complication in pregnancy that can increase the risk of maternal morbidity and mortality. Placenta accreta is a condition in which the implanted placental villi go too deep into the uterine wall. In the past few decades, the prevalence of placental cases in Indonesia has increased along with the increase in cesarean deliveries. Patients with post-hysterectomy can have changes in self-image acceptance that can affect psychological conditions and sexual satisfaction to post-traumatic stress disorder (PTSD). This study aims to determine how the effect of hysterectomy on the level of sexual satisfaction in placenta accreta patients in Indonesia. This study used a literature review study design. Research article searches were sourced from the PubMed, Google Scholar, and SCOPUS electronic databases. Search articles using keywords, namely hysterectomy, placenta accreta, sexual satisfaction. The results of a review of three journals that have been carried out show that the incidence of placenta accreta in placenta previa is quite worrying, namely as much as 25-50% and is a priority for cesarean section. The treatment that is often the choice is hysterectomy. The results showed that the effects of hysterectomy on women included orgasm problems, decreased libido, accelerated menopause, and nerve damage. This causes 10-20% of women to experience a decline in sexual function. The data that we reviewed can be concluded that although there are sexual dysfunction disorders in placenta accreta patients with hysterectomy therapy, there is no significant difference in the level of sexual desire between patients with hysterectomy and without hysterectomy in cases of placenta accreta.

Racial Differences in the Association of Endometriosis and Uterine Leiomyomas With the Risk of Ovarian Cancer.

To evaluate associations between endometriosis and uterine leiomyomas with ovarian cancer risk by race and the effect of hysterectomy on these associations. We used data from four case-control studies and two case-control studies nested within prospective cohorts in the OCWAA (Ovarian Cancer in Women of African Ancestry) consortium. The study population included 3,124 Black participants and 5,458 White participants, of whom 1,008 Black participants and 2,237 White participants had ovarian cancer. Logistic regression was used to calculate odds ratios (ORs) and 95% CIs for the associations of endometriosis and leiomyomas with ovarian cancer risk, by race, stratified by histotype and hysterectomy. The prevalences of endometriosis and leiomyomas were 6.4% and 43.2% among Black participants and 7.0% and 21.5% among White participants, respectively. Endometriosis was associated with an increased risk of endometrioid and clear-cell ovarian cancer in both racial groups (eg, OR for endometrioid tumors for Black and White participants 7.06 [95% CI 3.86-12.91] and 2.17 [95% CI 1.36-3.45], respectively, Phetereogeneity =.003). The association between endometriosis and ovarian cancer risk in White participants was stronger in those without hysterectomy, but no difference was observed in Black participants (all Pinteraction ≥.05). Leiomyomas were associated with an elevated risk of ovarian cancer only in those without hysterectomy in both Black (OR 1.34, 95% CI 1.11-1.62) and White (OR 1.22, 95% CI 1.05-1.41) participants (all Pinteraction ≥.05). Black and White participants with endometriosis had a higher risk of ovarian cancer, and hysterectomy modified this association among White participants. Leiomyomas were associated with an increased risk of ovarian cancer in both racial groups, with hysterectomy modifying the risk in both groups. Understanding how racial differences in access to care and treatment options (eg, hysterectomy) may help guide future risk reduction strategies.

Effect of Psychosexual Counseling Program on Sexual Quality of Life among Post-Hysterectomy Women

The effect of hysterectomy on sexual functioning differs from one woman to another. Although it is well known that hysterectomy may affect self-perceptions and self-esteem of women, it is emphasized that the sexual function of women who have to maintain their female identity, values, and sexuality is also affected. Sexual health is neglected by health professionals.

Menopausal symptoms among women with and without hysterectomy

BackgroundRecent studies have associated hysterectomies with an increased risk of several health adversities. However, the effect of hysterectomy on menopausal symptoms and menopause-related quality of life has not been explored much in Indian context. The present study aims to estimate the prevalence and severity of menopausal symptoms and their socio-demographic determinants among North Indian menopausal women with and without hysterectomy. MethodsThis cross-sectional study was conducted among 359 menopausal women aged 40–78 years, of which 266 were without hysterectomy, 66 had undergone hysterectomy before menopause, and 27 after menopause. The prevalence and severity of menopausal symptoms were captured using the MENQOL questionnaire. Appropriate statistical tests (including the chi-square test, t-test, and correlation analysis) were performed to understand the differences in the prevalence and severity of menopausal symptoms among the three groups. ResultsMenopausal symptoms, depending on the hysterectomy status, affected the quality of life of 66.2–78.79% of women. Notably, menopausal symptoms among those who underwent hysterectomy before menopause were significantly higher than those without hysterectomy in terms of both prevalence and severity [mean severity score (SD) = 3.49 (1.5) vs 2.85 (1.4), respectively; p-value= 0.001]. Higher age and longer duration since menopause were inversely correlated with the severity of symptoms among women without hysterectomy, but not among hysterectomized women. ConclusionHysterectomy before menopause may be associated with an increased prevalence of menopausal symptoms and poor quality of life. There is an urgent need to discourage unnecessary hysterectomies and facilitate women undergoing a hysterectomy with adequate post-surgery care.

Risk of Repeat Laparoscopy Following Surgical Diagnosis of Endometriosis: Effects of Hysterectomy, Oophorectomy, & Psychiatric Disease

<h3>Study Objective</h3> To quantify rates of repeat laparoscopy following initial surgical diagnosis of endometriosis and investigate risk factors associated with repeat surgery. <h3>Design</h3> Retrospective chart review of patients with surgical pathology confirming endometriosis. This study met exemption criteria (45CFR 46.101b) following IRB review. <h3>Setting</h3> Academic tertiary hospital system. <h3>Patients or Participants</h3> Women ages 12-50 receiving a primary surgical diagnosis of endometriosis, Jan 2017 - June 2018. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Demographic variables, type of initial procedure (hysterectomy, oophorectomy, other laparoscopy), presence of psychiatric disease (defined by pre-determined clinical criteria) and repeat laparoscopy within 3 years of initial diagnosis. 136 patients met inclusion criteria. Initial surgeries included unilateral oophorectomy (8.1%), bilateral oophorectomy (3.7%), hysterectomy without oophorectomy (22.1%), hysterectomy with unilateral oophorectomy (5.9%), and hysterectomy with bilateral oophorectomy (6.6%). 53.7% underwent other laparoscopy not involving hysterectomy/oophorectomy. 66 patients (49%) met criteria for psychiatric disease. 15 patients (11%) underwent repeat laparoscopy. Comparing patients who underwent repeat laparoscopy with those who did not, there was no difference in age (35.7±5.9 vs. 37.9±11.1 years, respectively, p=0.46), BMI (26.2±7.0 kg/m² vs. 28.5±6.7 kg/m², p=0.22), or race/ethnicity (32% vs. 67% White, Chi-square p=0.55). There was no association between re-operation and psychiatric disease (RR=1.2, 95%CI: 0.48-3.06, p=0.79). Preservation of ≥1 ovary was not associated with re-operation (RR=0.87, 95%CI: 0.26-3.34, p=0.69). Uterine preservation may be associated with a greater risk of repeat laparoscopy, with a trend towards significance (RR=2.5, 95%CI: 0.98-6.40, p=0.09). <h3>Conclusion</h3> The 3-year repeat laparoscopy rate was 11%, consistent with prior literature. Psychiatric disease was not associated with re-operation. Uterine preservation at time of initial laparoscopy may be associated with re-operation, but ovarian preservation was not. While non-significant findings may be limited by underpowering due to a small sample size, these results may help inform counseling and surgical planning in the long-term management of endometriosis.

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

PurposeHysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse.MethodsWe included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9–14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence.ResultsThe re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03).ConclusionHysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.

Effects of hysterectomy on pelvic floor function and sexual function-A prospective cohort study.

Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery. We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models. Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow-up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow-ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p< 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p< 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p< 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques. Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year.

The Effects of Hysterectomy on Urinary and Sexual Functions of Women with Cervical Cancer: A Systematic Review.

This systematic review aims at describing the prevalence of urinary and sexual symptoms among women who underwent a hysterectomy for cervical cancer. A systematic search in six electronic databases was performed, in September 2019, by two researchers. The text search was limited to the investigation of prevalence or occurrence of lower urinary tract symptoms (LUTS) and sexual dysfunctions in women who underwent a hysterectomy for cervical cancer. For search strategies, specific combinations of terms were used. A total of 8 studies, published between 2010 and 2018, were included in the sample. The average age of the participants ranged from 40 to 56 years, and the dysfunctions predominantly investigated in the articles were urinary symptoms (n = 8). The rates of urinary incontinence due to radical abdominal hysterectomy ranged from 7 to 31%. The same dysfunction related to laparoscopic radical hysterectomy varied from 25 to 35% and to laparoscopic nerve sparing radical hysterectomy varied from 25 to 47%. Nocturia ranged from 13%, before treatment, to 30%, after radical hysterectomy. The prevalence rates of dyspareunia related to laparoscopic radical hysterectomy and laparoscopic nerve sparing radical hysterectomy ranged from 5 to 16% and 7 to 19% respectively. The difficulty in having orgasm was related to laparoscopic radical hysterectomy (10 to 14%) and laparoscopic nerve sparing radical hysterectomy (9 to 19%). Urinary and sexual dysfunctions after radical hysterectomy to treat cervical cancer are frequent events. The main reported disorders were urinary incontinence and dyspareunia.

Effect of hysterectomy on the function of saved ovaries and correction of hormonal imbalance

The objective: to assess the hormonal disorders in patients after the radical treatment for leiomyoma and to develop the therapeutic options for correction.Materials and methods. The clinical and laboratory assessment of postoperative course after leiomyoma surgery in 160 women of reproductive age was carried out. The following groups of patients were formed: I group – 90 patients after vaginal hysterectomy (HE) with opportunistic salpingectomy and ovarian preservation, II group – 70 patients after abdominal HE with opportunistic salpingectomy and ovarian preservation. The control group included 50 women of reproductive age with asymptomatic leiomyoma.Then the following groups were formed to assess the effectiveness of the proposed medical correction program: the main group – 46 patients after vaginal HE with fallopian tubes and 36 persons after abdominal HE with fallopian tubes – received the proposed medical correction program, and the comparison group – 44 and 34 individuals after vaginal and abdominal HE with opportunistic salpingectomy and ovarian preservation, respectively, with standard approach for postoperative and rehabilitative periods.The diagnostic program included the assessment of hormonal level, post-hysterectomy syndrome degree by modified menopausal index using survey, urogenital and sexual dysfunction, and the indicators of vulvovaginal atrophy according to the Barlow scale.Results. Neurovegetative symptoms were observed in 36,7 % patients in the I group and 48.6 % - II group, vegetative-vascular symptoms – 46.7 % and 62.3 %, respectively. Insomnia was characterized by the sleep process disorders, the preservation of the feeling of fatigue after waking up. It is necessary to mention that an increase in the proportion of cardiovascular diseases up to 36 months after surgery (hypertension, dyshormonal cardiomyopathy and their combinations, 23.1 % were diagnosed with dyshormonal mastopathy, the women complained on arthralgia, morning joint stiffness, ostealgia twice more.The assessment of sexual disorders and manifestations of urogenital tract dysfunction allowed to indicate the most significant rate of dysuria complains in 72.9 % of cases in the II group after classical abdominal HE. Up to 36 months after surgery the subclinical hypothyroidism was found in 62.2 % of women in the I group and 31.4 % – II group, clinically significant hypothyroidism – in 21.1 % and 55.7 %, respectively.In the half of the cases the hormonal imbalance like hypoesrogenia was determined up to 36 months of monitoring without statistically significant differences between groups of different HE methodic. The main factor was patient’s age in which endocrine, vegetative-vascular disorders and the clinical manifestations of psychosomatic are developed in a larger percentage of significantly earlier in women of late reproductive age.The use of proposed program of therapeutic options after HE with ovarian preservation allowed to provide a tendency of the estradiol, progesterone and testosterone levels normalization, prolactin and cortisol concentrations were close to the reference values. Estradiol concentration in the women in main group increased, although it remained significantly below the age normal indices, and the most significant normalization of theses parameters were determined in women who received hormonal replacement therapy. Clinically positive effect in patients on the severity of neurovegetative and psychoemotional manifestations on the background of differentiated treatment was observed after 3 months from the beginning of therapy.Conclusions. The obtained results suggest that the optimization of the treatment program with the the proposed drugs in women in the groups leads to relative optimization of hormonal status and initiation of compensatory-adaptive responses of the organism, which improves the quality of life and eliminates symptoms of hypoestrogenism.

Effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of genitourinary syndrome and ways of its reduction

The article presents the assessment and analysis of the most important predictors and manifestations of genitourinary disorders in women of reproductive age after radical surgical treatment for uterine fibroids in the remote postoperative period. Ways of reducing the severity of symptoms are offered.&#x0D; The aim of the study – to establish the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on manifestation and progression of genitourinary syndrome and ways of the reduction in its severity.&#x0D; Materials and methods. Comprehensive clinical and laboratory assessment of the impact of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was conducted at the gynecological department of the “Kyiv Perinatal Center”. The study included 160 women: 90 patients underwent vaginal classical and laporoscopic hysterectomy including fallopian tubes removal; and 70 patients underwent abdominal hysterectomy including fallopian tubes removal. Data on the assessment of pelvic floor condition and urogenital dysfunction were provided using a standardized POP-Q system, both at the stage of preoperative observation and for 1, 3 and 5 years after the surgery.&#x0D; Research results and their discussion. The most important risk factors that allow forming groups of patients requiring individualized approach in the choice of surgical techniques and rehabilitation program were pointed out. The obtained results allowed to isolate UCDT markers in fractions above 20%. 19 women (11.86%) underwent ovarian surgeries and used gonadotropin-releasing hormone agonists. Genitourinary and sexual disorders were diagnosed in 27 cases (19.3%) 12 months after surgery. Vaginoscopy, performed 12 months after surgery, revealed atrophic vaginitis in 58 cases (36.25%) without significant difference in groups. Microscopy of urogenital smears was in norm only in 51 patients (31.86%). Complaints of dysuria were most common among patients (59 – 36.85%). The combination of sexual disorders and other manifestations (flatulence and intestinal discomfort, stool problems, vaginal microbiota disorders, pelvic floor descent, etc.) was revealed in a quarter of women (28 – 17.50%), and more often – after vaginal hysterectomy (17 – 18.89%). Clinical symptoms of urinary incontinence were observed against the background of a negative cough test in almost a third of patients (49 – 30.63%). They were combined with pollakiuria, nocturia, and imperative urgency, exacerbated by alcohol and accompanied by cystalgia and genital prolapse. The use of low doses of estradiol in the rehabilitation program improved the clinical and laboratory parameters of the urogenital tract, reducing the incidence of vulvovaginal atrophy by 13%, normalizing the biocenosis and vaginal pH, reducing clinical manifestations of urinary incontinence (pollakiuria and nocturnal pollakiuria) by 14%, feeling of incomplete bladder emptying – by 15%, stress urinary incontinence – by 16%, vaginal prolapse – by 11%, compared to the group with standard postoperative management, as well as reducing the severity of psycho-emotional and vegetative-vascular manifestations.&#x0D; Conclusion. The expected effect of surgical recovery may be insufficient, and clinical symptoms of genitourinary syndrome may manifest in the postoperative period, which requires the development of clear algorithms for diagnosing urinary incontinence and pelvic floor failure in the preoperative stage and application of long-term preventive measures after hysterectomy in the remote postoperative period. There is no statistically significant difference in the development of genitourinary syndrome with different surgical approaches.

Effect of Hysterectomy with Ovarian Conservation on Ovarian Function

Effect of Hysterectomy with Ovarian Conservation on Ovarian Function

Long-term effects of hysterectomy due to uterine fibroids in women of reproductive age

The article presents an analytical assessment of long-term postoperative consequences in women of reproductive age after hysterectomy for uterine fibroids.&#x0D; The aim of the study to determine the structure of long-term results of hysterectomy for uterine fibroids in women of reproductive age using different approaches to the possibility of optimizing the diagnostic algorithm in the preoperative period in the future.&#x0D; Materials and methods – 160 women aged 40 to 50 years with symptomatic uterine fibroids, who underwent hysterectomy performed by vaginal, laparoscopically assisted vaginal, abdominal, were examined. Research methods are the following: physical examination of patients, assessment of pelvic floor (cough test, Valsalva maneuver, “Stop Test” with Kegel cones), diagnosis of urogenital dysfunction using a standardized POP-Q system; instrumental examination:, complete urodynamic testing, cystometry, (for assessment of the severity of urinary incontinence the classification of the International Continence Society (ICS) was used); assessment of the patient’s quality of life on the 10th day after surgery, 3, 6, 12 months and three years after surgery using the international standard questionnaire MOS SF-36; study of the local infectious status of the female body (bacteriological and bacterioscopic examination of discharge from vagina and urethra, determination of vaginal pH&#x0D; Results and their discussion. The structure of distant postoperative manifestations was determined (after 36 months of postoperative monitoring): clinical manifestations of intestinal function discomfort in the same degree in patients of three subgroups, 2.4 and 2.9 times less often in group I patients indicated chronic pelvic pain, in 1.7 times less often - for genitourinary disorders, vaginal prolapse in a third of cases, especially in women with abdominal HE and classic vaginal HE (30.0±5.0 % and 37.8±5.0 %, respectively, against 17.8±4.0 % – in the group with laparotomically assisted HE).&#x0D; Conclusions. Given the data on genitourinary disorders and vaginal prolapse in almost a third of observations after hysterectomy for uterine fibroids, it is advisable to consider additional examination of latent signs of genitourinary syndrome at the preoperative stage to optimize the choice of access, the volume of surgical treatment.

Increased blood glucose level following hysterectomy among reproductive women in India

BackgroundIn recent years, the hysterectomy, a surgical removal of the uterus, has received increased attention in health policy debates in India. The trigger for this was a series of media reports that highlighted an unusual surge in the number of women undergoing hysterectomies with a significant number of cases involving young and early menopausal women from low-income families. When menopause occurs as a result of hysterectomy, then the hormones such as estrogen and progesterone affect how the body cells respond to insulin. To date, we have not come across a national study following blood glucose levels among women who undergo a hysterectomy.MethodsThe study used the Indian fourth round of National Family Health Survey data, which is a cross-sectional nationally representative sample of 699,686 women in the age group 15–49 years and conducted during 2015–16. Bivariate and multivariate logistic regressions were used to examine the effect of hysterectomy on blood glucose level of > 140 mg/dl among women of reproductive age groups.ResultsThe blood glucose level of > 140 mg/dl was much higher among women who had undergone a hysterectomy (12.2%) compared to non-hysterectomy women (5.7%). The pattern holds true among relevant background characteristics such as age, place of residence, education, caste, religion, wealth, marital status, body mass index (BMI), anaemia and consumption of tobacco. The adjusted odds after controlling for significant background factors, women who underwent hysterectomy experienced 15% higher odds of blood glucose level of > 140 mg/dl compared those who did not.ConclusionsThe results indicated increased blood glucose level among women post hysterectomy. Hence, the government of India should consider developing evidence-based policies and programming to provide effective targeted interventions for the better reproductive health of women.

Effect of hysterectomy on pain in women with endometriosis: a population-based registry study.

To assess pain symptoms before and after hysterectomy in women with endometriosis. A population-based registry study. Sweden. Women aged 18-45years who underwent hysterectomy for endometriosis between 2010 and 2015. Pain symptoms before hysterectomy and 12months after surgery were collected from the Swedish National Quality Register for Gynaecological Surgery (GynOp). Pain symptoms were also assessed by follow-up surveys after a median follow-up period of 63months. Pelvic or lower abdominal pain after hysterectomy. The study included 137 women. The proportion of women experiencing pain of any severity decreased by 28% after hysterectomy (P<0.001). The proportion of women with severe pain symptoms decreased by 76% after hysterectomy (P<0.001). The majority of women (84%) were satisfied with the surgical result. Presence of severe pain symptoms after the hysterectomy was associated with less satisfaction (P<0.001). Pain symptoms after surgery, patient satisfaction and the patient's perceived improvement were not significantly different between women whose ovarian tissue was preserved and women who underwent bilateral oophorectomy. We observed a significant, long-lasting reduction in pain symptoms after hysterectomy among women with endometriosis. Hysterectomy, with the possibility of ovarian preservation, may be a valuable option for women with endometriosis who suffer from severe pain symptoms. Hysterectomy is a valuable option for women with endometriosis and severe pain symptoms.

¿Cambia la función sexual tras la histerectomía?

ObjectiveWomen may experience anxiety because of the possible effects of hysterectomy on sexual function, but studies have shown conflicting results on this topic. Given the frequency of this procedure, the aim of this study is to determine whether sexual function changes after hysterectomy. Material and methodsA comparison was made of sexual function before hysterectomy to sexual function at 3 and 9 months after the procedure in 299 women who underwent hysterectomy between 1 November 2012 and 30 November 2014, at the Hospital and University Complex of Albacete, Spain. A total of 166 women were finally included in the study. Sexual function was studied using the Women's Sexual Function Questionnaire (Cuestionario de Función Sexual de la Mujer, FSM®). ResultsIt was found that some aspects of female sexual function improved after hysterectomy, whereas others did not change. Those younger than 55 years old experience improvements in sexual desire, excitement, and frequency of sexual activity, and had a decrease in problems with vaginal penetration. These changes were all evident 3 months post-intervention, and no changes occurred thereafter. Anticipatory anxiety also improved between the third and ninth month. An upward trend was observed in the general enjoyment of sex life. In those older than 55 years, an increase was only found in the frequency of sexual activity at 9 months post-operation. ConclusionsAfter hysterectomy, female sexual function either improves or remains unchanged. Improvement is primarily found in women younger than 55 years old.

Effect of Hysterectomy on Ovarian Reserve in the Early Postoperative Period Based on the Type of Surgery.

ObjectivesThis study aimed to evaluate the influence of simple hysterectomy on the ovarian reserve based on the type of surgery.MethodsEighty-six premenopausal women between 31 and 48 years who underwent hysterectomy for benign gynecologic disease without additional adnexal surgery at a university hospital participated in this study. Seventy-one patients underwent laparoscopy-assisted vaginal hysterectomy (LAVH), and 15 patients underwent abdominal hysterectomy (AH). Blood samples were obtained from all study participants on preoperative day and 3 days after the operation to determine the anti-Müllerian hormone (AMH) levels.ResultsThe postoperative reduction of the mean serum AMH level in the LAVH group (0.42 ± 0.76 ng/mL) was greater than that in the AH group, although the difference was not statistically significant (0.01 ± 0.60 ng/mL) (P = 0.053). The mean baseline AMH level (2.59 ± 2.33 ng/mL) was significantly reduced to 2.24 ± 2.08 ng/mL at 3 days after hysterectomy, and the mean rate of decline of AMH levels after surgery was 13.61% ± 30.81%. In subgroup analysis based on the type of surgery, the mean serum AMH level decreased significantly after surgery in the LAVH group, but no significant changes were found in serum AMH levels before and after the surgery in the AH group.ConclusionsThese preliminary results suggest that simple hysterectomy affects the early postoperative decline of ovarian reserve, and these results might vary depending on the type of surgery.

The Impact of Robotic Assisted Total Laparoscopic Hysterectomy on Pelvic Floor Function and Sexual Function.

Study Objective To investigate the long-term effects of hysterectomy on benign indication on pelvic floor function and sexual function. Design Prospective clinical cohort study Setting Academic affiliated district general hospital. Patients or Participants Patients undergoing hysterectomy for benign disease between 2016 and 2018 Interventions A comparison of robotic assisted total laparoscopic hysterectomy with traditional techniques of surgery regarding pelvic floor function and sexual function. Measurements and Main Results The study includes 259 women going through hysterectomy. Participants fills in validated questionnaires (PFIQ, PFDI-20, FSFI) on pelvic floor function and sexual function before surgery, six months, 1, 3 and 5 years after surgery. General health and obstetric history are registered in a separate protocol. Multivariate regression and nonparametric statistics are used. The one-year results are not complete but will be presented in November 2019. The results for the six-months follow up of the first 150 women show that the mean age at surgery was 50.2 (SD 9,7), the mean parity was 1,8 (SD 1,2) and mean BMI was 26.4 (SD 4.9). Robotic assisted laparoscopic hysterectomy was performed in 37,3% of the women, laparoscopic hysterectomy in 22%, laparoscopically assisted hysterectomy in 1,1%, vaginal hysterectomy in 3,3% and abdominal hysterectomy in 36,7%. There was a significant higher amount of bleeding at surgery 453 ml (range 50-1300) in the abdominal cohort. Urinary, bladder and pelvic symptoms were significantly reduced six months after hysterectomy. The reduction of symptoms was most prominent in the abdominal hysterectomy cohort but also significant in the robotic hysterectomy cohort. There were no significant changes in sexual function in the cohorts after six months. Conclusion There was a reduction of urinary, bladder and pelvic symptoms six months after hysterectomy but no differences in sexual function. Remaining analysis will show whether those results persist at the one-year follow-up.

Effects of hysterectomy with simultaneous bilateral salpingectomy on the subsequent pelvic mass

ObjectivesTo analyze the clinicopathological characteristics of subsequent pelvic masses after hysterectomy for benign diseases, and to compare the masses following hysterectomy with or without simultaneous bilateral salpingectomy.MethodsThis study retrospectively analyzed patients undergone reoperation for pelvic mass subsequently to previous hysterectomy for benign disease from January 2012 to December 2016 in Peking Union Medical College Hospital.ResultsA total of 247 patients were enrolled in this study, of which 80.16% (n = 198) received simple hysterectomy, and 5.67% (n = 14) underwent hysterectomy with bilateral salpingectomy. The clinicopathological data of patients undergone simple hysterectomy or simultaneous bilateral salpingectomy was compared. In the former group, we found that 68.18% (n = 135) of the pelvic massed were benign, and the remaining 31.82% (n = 63) were malignant. In latter group, 57.10% (n = 8) were benign (8%) and 42.90% (n = 6) were malignant. Univariate analysis showed that the age of surgery for pelvic masses in patients undergoing hysterectomy with simultaneous bilateral salpingectomy was significantly younger than that in patients without salpingectomy (median, 44.5 vs 50 years, P < 0.0001), and the time interval between hysterectomy and onset of pelvic masses was also significantly shorter (median, 2 vs 5 years, P < 0.0001). And the probability of pelvic encapsulated effusion was significantly higher for the salpingectomy group. Multivariate analysis showed that there was no significant difference of the age of resection of pelvic mass, the time interval hysterectomy and pelvic mass onset, and the probability of pelvic encapsulated effusion between the two groups.ConclusionsThe results showed that the incidence of secondary benign pelvic masses may be reduced when hysterectomy was performed with simultaneous bilateral salpingectomy. However, there was no statistical difference in the clinical characteristics and pathological types of pelvic masses between patients received hysterectomy with or without salpingectomy.

The effects of hysterectomy with bilateral salpingectomy on ovarian reserve.

To determine whether ovarian reserve is compromised after hysterectomy with bilateral salpingectomy. A prospective longitudinal study was conducted among 84 women who underwent hysterectomy with bilateral salpingectomy at a tertiary medical center in Beijing, China, between August 2, 2015, and January 15, 2017. Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured to assess ovarian function before undergoing the procedure (baseline) and at weeks 1 and 6 after surgery (postoperative period). The median age was 41.61±0.62years. Age negatively correlated with the serum AMH level at baseline (P<0.001), as well as with preoperative-to-postoperative changes in the concentration of this hormone (P<0.001). Serum AMH levels were lower in the postoperative period versus the preoperative period (P<0.001). By contrast, serum FSH levels were higher in the postoperative period than in the preoperative period (P<0.001). Moreover, no correlation was found with body mass index. Hysterectomy with bilateral salpingectomy compromised ovarian reserve, with the damage being most severe among younger patients.