Hysterectomy For Uterine Fibroids Research Articles

234 - Hysterectomy for Uterine Fibroids and Anti-urinary Incontinence Surgery: A Nationwide Cohort Study

234 - Hysterectomy for Uterine Fibroids and Anti-urinary Incontinence Surgery: A Nationwide Cohort Study

Patient Characteristics Associated With Embolization Versus Hysterectomy for Uterine Fibroids: A Systematic Review and Meta-Analysis

IntroductionBlack and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UFs) and experience more severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than the common alternative, open hysterectomy. To determine whether demographic disparities persist in UF treatment utilization, we reviewed patient characteristics associated with UAE versus hysterectomy for UF among studies of US clinical practices. MethodsA systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051), yielding 1,350 articles (January 1, 1995, to July 15, 2023) that outlined demographic characteristics of UAE compared with hysterectomy. Two readers screened for inclusion criteria, yielding 13 full-text US-based comparative studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed on the data (STATA v18.0). Egger’s regression test was used to quantify publication bias. ResultsNine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio = 3.35, P < .01) and young age (P < .05) were associated with UAE, whereas private insurance (relative to Medicare and/or Medicaid) was not (odds ratio = 1.06, P = .52). Between-study heterogeneity (I2 > 50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. Conclusions and ImplicationsKnowledge of demographic characteristics of patients with UFs receiving UAE versus hysterectomy is sparse (n = 13 studies). Among these studies, which seem to be racially well distributed, Black and younger women are more likely to receive UAE than their counterparts.

Attitudes and Beliefs about Hysterectomy in Patients with Uterine Fibroids

To investigate the attitudes toward and beliefs about hysterectomy that influence the decision of women with symptomatic uterine fibroids regarding hysterectomy. A prospective survey study. An outpatient clinic. Patients in an urban, academic complex gynecology outpatient clinic at the age of 35 years or older with uterine fibroids and without previous hysterectomy were invited to participate. A total of 67 participants were surveyed between December 2020 and February 2022. Data were collected on demographics, Uterine Fibroid Symptom Health-Related Quality of Life (UFS-QOL) Questionnaire scores, and beliefs regarding hysterectomy via a web-based survey. Participants were posed with clinical scenarios and asked to indicate a preference for hysterectomy or myomectomy and stratified into groups by acceptability of hysterectomy as a treatment option for fibroids. Data were analyzed using chi-square or Fisher exact tests, t tests, or Wilcoxon tests as appropriate. The mean age of participants was 46.2 (SD 7.5) years, and 57% of participants self-identified as White/Caucasian. The mean UFS-QOL symptoms score was 50 (SD 26) and the mean overall health-related quality of life score was 52 (SD 28). Notably, 34% of participants preferred hysterectomy whereas 54% preferred myomectomy assuming equivalent efficacy; 44% of those who preferred myomectomy did not desire future fertility. There were no differences observed in UFS-QOL scores. Participants opting for a hysterectomy believed that it would improve their mood/emptions, relationship with partner, general quality of life, sense of femininity, feeling whole, identity/body image, sexuality, and relationships. Those who opted for a myomectomy believed all those factors would worsen with a hysterectomy, and in addition, it would worsen their vaginal moisture and their partner's experience. Many factors affect a patient's decisions regarding hysterectomy for uterine fibroids beyond those related to fertility, including factors related to body image, sexuality, and relationships. Physicians should consider these factors when counseling patients and recognize their importance to facilitate improved shared decision making.

MP37-01 HYSTERECTOMY FOR UTERINE FIBROIDS AND STRESS URINARY INCONTINENCE SURGERY: A NATIONWIDE COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP37-01 HYSTERECTOMY FOR UTERINE FIBROIDS AND STRESS URINARY INCONTINENCE SURGERY: A NATIONWIDE COHORT STUDY Jun Ho Lee Jun Ho LeeJun Ho Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Uterine fibroids (myomas or leiomyomas) are the most common benign uterine neoplasm. Hysterectomy is the most effective treatment for symptomatic uterine fibroids and uterine fibroids are currently the most common indication for hysterectomy worldwide. Previous studies investigated the relationship between the previous hysterectomy for benign conditions and subsequent stress urinary incontinence (SUI). However, the results are inconsistent across the studies. Additionally, long-term follow-up data from large data sets are lacking. Moreover, the impact of the previous hysterectomy for benign indication on subsequent surgery for SUI is scarcely investigated. METHODS: A retrospective cohort study was conducted on women aged 40 to 59 from the Korean Health Insurance Data 2010 to 2018. The hysterectomy group consisted of women who underwent hysterectomy for uterine leiomyoma and the control group consisted of women who visited a medical facility for a checkup between January, 2011 and December, 2014. Main outcome measures included the occurrence of stress incontinence surgery (R3564, R3565, R3562, R3563) with a urinary incontinence diagnosis code (N39.3, N39.4). For the selected hysterectomy group and control group, 1:1 propensity score matching was done on age at 5-year intervals, year at inclusion, socioeconomic status, parity, region, Charlson Comorbidity Index, adnexal surgery before inclusion, menopause before inclusion, menopausal hormone therapy, and pelvic organ prolapse before inclusion. RESULTS: After 1:1 propensity score matching, 81,373 cases and 81,373 controls were enrolled. The mean follow-up period was 7.9 years for cases and 7.8 years for control subjects. The rate of anti-incontinence surgery was significantly higher in the hysterectomy group compared to the non-hysterectomy group (1.7 vs. 2.0%; p<.001). As compared to the non-hysterectomy group, abdominal hysterectomy significantly increased anti-incontinence surgery before and after adjusting confounders (HR: 1.215; 95% CI: 1.097-1.347; p<.001). However, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery did not increase anti-incontinence surgery as compared to the non-hysterectomy group before and after adjusting confounders. This significant relationship between abdominal hysterectomy and anti-incontinence surgery was maintained after stratifying patients according to age group. CONCLUSIONS: In conclusion, hysterectomy, especially transabdominal hysterectomy significantly increases the risk of subsequent anti-incontinence surgery. Our data suggest that patients who plan to undergo transabdominal hysterectomy for the treatment of uterine fibroids should know and be counseled about the risk of SUI and especially the risk of anti-incontinence surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e513 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jun Ho Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Hysterectomy for uterine fibroids and stress urinary incontinence surgery: A nationwide cohort study

Hysterectomy for uterine fibroids and stress urinary incontinence surgery: A nationwide cohort study

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

BackgroundAs a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective.MethodsAn economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness.ResultsMean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03–264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35–4.71) for major surgical complications; 6.75% (95%CI: 6.45–7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23–1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76–5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81–3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97–210.95) per week saved to return to normal activities.ConclusionsTLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.

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.

Quality of life after laparoscopic hysterectomy versus abdominal hysterectomy

BackgroundLaparoscopic surgery has been described as a minimally invasive surgery. The purpose of this study is to clarify its minimal invasive features using a patient questionnaire on the postoperative quality of life (QOL) over various time periods following either laparoscopic hysterectomy (LH) or abdominal hysterectomy (AH) and to compare the results.MethodsThis study enrolled 28 patients who underwent total hysterectomy for uterine fibroids in 2012 (14 AH cases and 24 LH cases) were enrolled in this study. The 36-Item Short Form Survey (SF-36) questionnaire was completed on postsurgical day 3; weeks 1, 2, and 4; and month 6. The results were compared between the two groups.ResultsPatients who underwent LH scored significantly higher on physical functioning on postoperative day 3 and week 2; physical role and bodily pain on day 3 and week 1; general health on postoperative day 3, weeks 1, 2, and 4, and month 6; social functioning on day 3; and emotional role on day 3 and week 1. No significant differences were found between vitality and mental health at any time point or in the categories above at any other time point.ConclusionsPostoperative QOL in LH cases was improved on day 3 and week 1; however, no significant differences between the LH and AH groups were found in most categories at week 4 and month 6. LH leads to superior short-term QOL early in the postoperative period relative to AH.

Predictors of genitourinary syndrome in women of elderly reproductive age after hysterectomy

The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.

Intraoperative transradial angiography augments safe hysterectomy for uterine fibroids in the setting of ambiguous arterial anatomy: a case report

BackgroundTransfemoral access is the traditional gold standard for uterine artery angiography; however, transradial access is gaining in popularity because of its decreased complication profile and patient preference. We present a case of a patient who underwent successful total abdominal hysterectomy for symptomatic uterine fibroids with ambiguous pelvic vasculature that would have been otherwise aborted if it were not for intraoperative transradial access angiography.Case presentationA 52-year-old Caucasian woman presented to her gynecologist for an elective total abdominal hysterectomy and bilateral salpingo-oophorectomy. During preoperative imaging, a 15-cm mass consistent with a uterine fibroid was identified, and the patient’s gynecologist decided to treat her with surgical resection, given the fibroid’s size. The procedure was halted upon discovery of a complicated vascular plexus at the fundus of the uterus, and an intraoperative vascular consult was requested. The vascular operator used a transradial access to perform pelvic angiography in real time to identify the complicated pelvic vasculature, which allowed the gynecologist to surgically resect the uterine fibroid. The patient was discharged on postoperative day 4 without any complications.ConclusionsIntraoperative imaging is a useful technique for the identification of complicated anatomical structures during surgical procedures. The successful outcome of this case demonstrates an additional unique benefit of transradial access and highlights an opportunity for interdisciplinary collaboration for management of complicated surgical interventions.

Clinical effect of enhanced recovery after surgery management in patients with vaginal hysterectomy

Objective To analyze the effect of enhanced recovery after surgery program(ERAS) in perioperative management of vaginal hysterectomy. Methods The clinical data of 73 patients who underwent transvaginal hysterectomy for uterine fibroids, adenomyosis, middle pelvic defects, cervical lesions and endometrial lesions were retrospectively analyzed.All patients were divided into two groups according to the perioperative management method.The observation group (35 cases) received the enhanced recovery program, while the control group (38 cases) received the routine perioperative management.The general data and perioperative management indicators of the two groups were recorded and compared. Results There were no statistically significant differences between the two groups in mean age, body mass index, abdominal surgery history and diagnosis constitution(all P>0.05). The first feeding time[(7.6±1.3)h vs.(12.6±3.2)h], postoperative exhaust time[(15.5±4.6)h vs.(20.2±6.5)h], indwelling catheter time[(20.1±4.9)h vs.(28.4±6.8)h], mobilization time[(19.2±3.5)h vs.(24.2±7.9)h], the length of hospital stay[(4.5±0.7)d vs.(5.8±1.2)d]and hospitalization expense[(6 545.2±430.7)CNY vs.(7 953.8±653.3)CNY]of the observation group were less than those of the control group, the differences were statistically significant(t=8.069, 3.538, 5.938, 3.582, 5.590, 10.777, all P 0.05). Conclusion The ERAS program perioperative management can speed up the postoperative recovery process, reduce the length of hospital stay and the financial burden of patients who underwent transvaginal hysterectomy. Key words: Surgical procedures, operative; Practice management, medical; Hysterectomy, vaginal

Consequences of the FDA Warnings About Power Morcellation

In April 2014, the FDA issued a statement discouraging use of laparoscopic power morcellation in hysterectomy for uterine fibroids; this was followed

Potential Role of Semaphorin 3A and Its Receptors in Regulating Aberrant Sympathetic Innervation in Peritoneal and Deep Infiltrating Endometriosis.

Previous studies have demonstrated the involvement of nerve repellent factors in regulation of the imbalanced innervation of endometriosis. This prospective study aims to explore the role of Sema 3A in regulating aberrant sympathetic innervation in peritoneal and deep infiltrating endometriosis. Ectopic endometriotic lesion were collected from patients with peritoneal endometriosis (n = 24) and deep infiltrating endometriosis of uterosacral ligament (n = 20) undergoing surgery for endometriosis. Eutopic endometrial samples were collected from patients with endometriosis (n = 22) or without endometriosis (n = 26). Healthy peritoneum (n = 13) from the lateral pelvic wall and healthy uterosacral ligament (n = 13) were obtained from patients who had no surgical and histological proof of endometriosis during hysterectomy for uterine fibroids. Firstly, we studied the immunostaining of Sema 3A, Plexin A1 and NRP-1 in all the tissues described above. Then we studied the nerve fiber density (NFD) of endometriosis-associated (sympathetic) nerve and para-endometriotic (sympathetic) nerve by double immunofluorescence staining. Finally we analyzed the relationship between expression of Sema 3A in stromal cells of endometriotic lesion and the aberrant innervation of endometriosis. Semi-quantitative immunostaining demonstrated that (1) Higher immunostaining of Sema 3A were found in the eutopic endometrial glandular epithelial cells from patients with endometriosis (p = 0.041) than those without endometriosis; (2) Sema 3A immunostaining was higher in glandular epithelial cells of peritoneal endometriosis (P<0.001) and deep infiltrating endometriotic lesions of uterosacral ligament (P = 0.028)compared with glandular epithelial cells of the endometrium from women with endometriosis, while its expression in ectopic stormal cells in both groups were significantly lower than that from eutopic endometrium of women without endometirosis (P<0.001, P<0.001, respectively). NFDs of Anti-TH (+) endometriosis-associated sympathetic nerve of peritoneal endometriosis (p<0.001) and deep endometriosis of uterosacral ligament (p<0.001) were significantly lower than NFDs of para-endometriotic sympathetic nerve. Our results suggest that Sema 3A may contribute to the regulation of aberrant sympathetic innervation in peritoneal and deep infiltrating endometriosis.

The Association Between Occupational Characteristics and Hysterectomies for Treating Uterine Fibroids in Taiwan

This study examined the relationship between the occupational characteristics of women with uterine fibroids (UFs) and the decision to have a hysterectomy. Data from the Longitudinal Taiwan Health Insurance Database (LTHID) from 2000 to 2009 were analyzed to investigate the association between occupation and hysterectomies. Multivariable logistic regression analysis showed that, compared with white-collar UF patients, the odds ratio (OR) for hysterectomy surgery was 1.21 (95% confidence interval (CI) = 1.11–1.32) for blue-collar UF patients. Moreover, non-government employees with UFs also had significantly increased odds of having a hysterectomy compared to government employees with UFs (OR = 1.19, 95% CI = 1.04–1.36). This study provides information regarding the extent to which differences in occupation and decision-making processes might affect the marked variations in the use of hysterectomies for UFs.

Expression of human β-defensin-2 in the eutopic and ectopic endometrial tissues in patients with endometriosis

To investigate the expression of human β-defensin-2 (hBD-2) in the endometrium of patients with endometriosis (EMS) and explore the potential role of hBD-2 in the pathogenesis of EMS. Prospective controlled study. 50 women including EMS patients undergoing laparoscopic ovarian cystectomy and non-EMS patients undergoing hysterectomy for uterine fibroids. Large university teaching hospital. Patients were divided into EMS and non-EMS groups. The gene expressions of hBD-2, interleukin (IL)-1β and tumor necrosis factor (TNF)-α in the endometrial tissues of each group were detected with real-time quantitative polymerase chain reaction (PCR), and hBD-2 protein expression with immunohistochemical method. The gene expression levels of hBD-2, TNF-α, and IL-1β as well as the positive expression rate of hBD-2 protein in the ectopic endometrium of EMS patients were significantly higher than those in the eutopic endometrium of EMS and non-EMS patients (all P < 0.05). Correlation analysis showed that the gene expression levels of hBD-2 in the ectopic and eutopic endometrium of EMS patients were positively correlated with the gene expression levels of IL-1β and TNF-α (P < 0.01). High levels of hBD-2 gene and protein expressions in the ectopic endometrium of EMS patients may be an important contributor in the pathogenesis of EMS. TNF-α and IL-1β may promote the upregulation of hBD-2 expression.

Transvaginal appendectomy with traditional laparoscopic tools

To establish the technique and methodology of appendectomy through transvaginal natural orifice transluminal endoscopic surgery(NOTES)under laparoscopy. Three cases of chronic appendicitis were selected to receive laparoscopic transvaginal resection of appendixes with concurrent vaginal hysterectomies for uterine fibroids at Shengjing Hospital of China Medical University from November 2010 to November 2011. The procedure was performed by a multidisciplinary team composed of surgeons and gynecologists. The clinical data such as operative duration, bleeding volume, morbidity and stay duration were collected and analyzed. Appendectomies were performed with the working laparoscopic tools inserted through vagina. The en bloc resection was removed transvaginally through laparoscope. It took 34, 23 and 26 minutes respectively to complete the appendectomies. And the blood loss volume was minimal. There were no postoperative complications. And the patients were discharged scar-free after 3 days. Transvaginal appendectomy is both feasible and safe when performed by a multidisciplinary team. As an emerging innovation, natural orifice transluminal endoscopic surgery is mini-invasive, better tolerated and more respectful of esthetics.

Clear cell carcinoma arising in the abdominal wall: two case reports and literature review

Clear cell carcinoma originating in the abdominal wall is rare and usually develops within endometriotic implants in the scar. We describe 2 patients: a 42 year old with a 15 cm mass on the abdominal wall treated with neoadjuvant chemotherapy and excision and a 51 year old with a 6 cm abdominal mass treated with excision and adjuvant radiotherapy.

Benign Metastasizing Leiomyoma: A Rare Cause of Multiple Pulmonary Nodules

Benign metastasizing leiomyoma (BML) is a rare cause of pulmonary nodules that occurs when uterine leiomyomas metastasize to the lung. The management of these lesions varies from resection and hysterectomy to nonsurgical treatments such as hormonal therapy. We report a case of a 45-year-old woman with multiple nodules of the right lung identified during preoperative imaging before her hysterectomy for uterine fibroids.

Clinic application of the transvaginal hysterectomy

Objective To study the efficacy and safety of transvaginal hysterectomy for uterine fibroid treatment.Methods Clinical data of patients with normal positioned benign uterine diseases treated by vaginal hysterectomy(Vaginal Group)were retrospectively reviewed,to evaluate the clinical effects of transvaginal hysterectomy.Results 9 cases(28.1％)of type O uterine fibroid were found.16 cases(50％)of type Ⅰ,and 7 cases(21.9％)of type Ⅱ.30 cases were accepted as satisfactory therapy effect,with satisfactory degree of 93.8％.Conclusion Transvaginal hysterectomy is the best choice for treating uterine fibroid,and enhancing monitoring body signs and symptoms during operation and B ultrasonic inspection are the key factors for improving the treatment effect and safety. Key words: Transvaginal hysterectomy; Hysterectomy; Hysteroscope

Indications for abdominal hysterectomy at the Jos University Teaching Hospital.

Objective: Abdominal Hysterectomy is an everyday procedure in the Department of Obstetrics and Gynaecology of the Jos University Teaching Hospital. There is, however, dearth of data on the indications for and, pattern of morbidity and mortality of this procedure from this centre. This prompted the review. Methodology: This was a retrospective study of all Abdominal Hysterectomies done in the Department of Obstetrics and Gynaecology of the Jos University Teaching Hospital (JUTH), Jos, Plateau state, North Central Nigeria over a four year period (2002-2005). Results: Abdominal hysterectomy accounted for 10.8% of all major gynaecological operations during the study period. The age group of 40-44 years accounted for 50% of the patients that had total abdominal hysterectomy. Uterine fibroid was the commonest indication, which accounted for 89.5% of cases. The morbidity rate was 33% and there was no mortality. Conclusion: Hysterectomy for Uterine fibroids was the commonest indication for l Abdominal Hysterectomy. Though postoperative morbidity was high (33%), there was no mortality.Key words: Abdominal Hysterectomy, Uterine Fibroids, morbidity, Jos University Teaching Hospital.