Hysterectomy For Abnormal Uterine Bleeding Research Articles

A National Database Study on Racial Disparities in Route of Hysterectomy with a Surrogate Control for Uterine Size: A Proposed Quality Metric for Benign Indications

Study ObjectiveTo investigate the association between race and route of hysterectomy among patients undergoing hysterectomy for abnormal uterine bleeding in the absence of uterine fibroid disease and excluding malignancy. DesignA cross-sectional cohort study utilizing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and National Ambulatory Surgical databases to compare abdominal to minimally invasive route of hysterectomy. SettingHospitals and hospital-affiliated ambulatory surgical centers participating in the Healthcare Cost and Utilization Project in 2019 Patients75,838 patients who had undergone hysterectomy for abnormal uterine bleeding excluding uterine fibroids and malignancy. Interventionsn/a Measurements and Main ResultsOf the 75,838 hysterectomies performed for abnormal uterine bleeding in the absence of uterine fibroids and malignancy, 10.1% were performed abdominally and 89.9% minimally invasively. After adjusting for confounders, Black patients were 38% more likely to undergo abdominal hysterectomy compared to White patients (OR 1.38, CI 1.12-1.70 p=0.002). Black race thus is independently associated with open surgery. ConclusionDespite excluding uterine fibroids as a risk factor for an abdominal route of hysterectomy, Black race remained an independent predictor for abdominal versus minimally invasive hysterectomy and Black patients were found to undergo a disproportionately higher rate of abdominal hysterectomy compared to White patients.

The frequency of structural causes (PALM) according to FIGO PALM-COEIN classification in patients undergoing hysterectomy for abnormal uterine bleeding

Aims: We aimed to determine the frequency of the PALM group in the FIGO PALM-COEIN system of patients who were operated for AUB, and to evaluate and analyze our data in our clinic. Methods: In a retrospective study, data were obtained for nonpregnant women aged 18–55 years who underwent hysterectomy for AUB at a center in Turkey in 2017-2022. The patients were retrospectively classified according to the PALM-COEIN system. Results: A total of 847 women were included. Leiomyoma was the most common pathology result in only 377 (44.5%) patients. The second most common pathology result was adenomyosis and leiomyoma coexistence in 132 (15.6%) patients. The third most common pathology result was 62 (7.3%) adenomyosis. Conclusion: In addition to the combined use of FİGO AUB system 1 and 2 in AUB, the notation grouping may be useful for clinicians in the management of AUB.

The Role of Endometrial Sampling before Hysterectomy in Premenopausal Women with Abnormal Uterine Bleeding.

Background/Objectives: An endometrial sampling is recommended for patients experiencing abnormal uterine bleeding above the age of 40 or 45. Valid risk prediction models are needed to accurately assess the risk of endometrial cancer and avoid an unnecessary endometrial biopsy in premenopausal women. We aimed to assess the necessity and usefulness of preoperative endometrial sampling by evaluating premenopausal women who underwent hysterectomy for abnormal uterine bleeding after preoperative endometrial sampling at our clinic. Methods: A retrospective analysis was conducted on 339 patients who underwent preoperative endometrial sampling and subsequently underwent hysterectomy due to abnormal uterine bleeding. Detailed gynecologic examinations, patient histories, and reports of endometrial sampling and hysterectomy were recorded. Cohen's Kappa (κ) statistic was utilized to evaluate the concordance between histopathological results from an endometrial biopsy and hysterectomy. Results: The mean age of the cohort was 47 ± 4 years. Endometrial biopsies predominantly revealed benign findings, with 137 (40.4%) cases showing proliferative endometrium and 2 (0.6%) cases showing endometrial cancer. Following hysterectomy, final pathology indicated proliferative endometrium in 208 (61.4%) cases, with 7 (2.1%) cases showing endometrioid cancer. There was a statistically significant but low level of concordance between histopathological reports of endometrial biopsy and hysterectomy results (Kappa = 0.108; p < 0.001). Significant differences were observed only in the body mass index of patients based on hysterectomy results (p = 0.004). When demographic characteristics were compared with cancer incidence, smoking status and preoperative endometrial biopsy findings showed statistically significant differences (p = 0.042 and p = 0.010, respectively). Conclusions: The concordance between the pathological findings of a preoperative endometrial biopsy and hysterectomy is low. Body mass index is an important differentiating factor between benign histopathologic findings of endometrium and endometrial neoplasia. Moreover, adenomyosis was found to be associated with endometrial cancer cases. The current approach to premenopausal women with abnormal uterine bleeding, which includes a routine endometrial biopsy, warrants re-evaluation by international societies and experts.

Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas

Background Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches. Objective To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis. Methods The Kaiser Permanente Hysterectomy Database (KPHD) was searched for women aged 18–52 undergoing hysterectomy for leiomyoma-associated chronic AUB (AUB-L) in 2018 and 2019. A target sample of 400 comprised those with at least 3 years in the Health System. Radiologists evaluated preoperative pelvic ultrasound images to determine leiomyoma size and level 2 FIGO type (submucous or other), and the linked electronic medical record abstracted for clinical features, including histopathological evidence of adenomyosis. Results Of the 370 subjects that met the study criteria, adenomyosis was identified via histopathology in 170 (45.9%). There was no difference in the adenomyosis prevalence with (47.1%) and without (43.0%) at least one submucous leiomyoma. Subgroup analysis of ultrasound images by an expert radiologist for the presence of adenomyosis demonstrated a positive predictive value of 54.0% and a negative predictive value of 43.4%. Conclusions Adenomyosis was present in almost half of this AUB-L cohort undergoing hysterectomy and was equally prevalent in those with and without submucous leiomyomas as determined by sonographic evaluation. The imaging findings are in accord with prior investigators and demonstrate that 2-D ultrasound is insensitive to the presence of adenomyosis when the uterus is affected by leiomyomas. Further research is necessary to determine the impact of various adenomyosis phenotypes on the presence and severity of the symptom of HMB.

Huge Rare Vaginal Fibromatosis in Postmenopausal Woman, Case Report and Literature Review, 2022

Background: Pelvic fibromatosis or desmoids tumor is an uncommon benign mesenchymal tumor that usually involves the vulvo-vaginal area in women of reproductive age, which are slow growing and painless mass. Case Report: A 70-year post-menopausal woman from Asmara presented with genital swelling which grows gradually over 15 years. She had history of trans-abdominal hysterectomy for abnormal uterine bleeding before 20 years. She had also history of right sided body weakness due to cerebro-vascular accident for the last10 years. She had no known chronic diseases such as hypertension or diabetes mellitus. On physical examination, she is a wheelchair patient with right sided hemiplegia and old midline abdominal scar. On genitourinary examination, patient had a large, about 20x18cm, non-tender, irregular, nodular mass, that hangs from the right side of the labia majora to the level of one third of upper thigh. She had also multiple nodular lesions around the ano-genital area. Different laboratory baseline investigations revealed normal finding. She was operated on 30/10/2022 and a 4kg vulvar mass was resected with right partial hemi-vulvoctomy and sample was sent for pathology which revealed fibromatosis. She was discharged with full improvement and currently on follow-up for possible recurrence. Conclusion: This is reported for its rarity and its enormously large size, slow growing and non-invasive nature. Besides, this was atypical being in a postmenopausal woman, and it’s important to highlight that desmoids tumors should be included in the differential diagnosis of any vulvar mass. She was managed with surgical intervention as it was extremely big. Enhancing community and health professionals’ awareness on similar health problems is crucial for early intervention of similar r conditions.

Small Cell Neuroendocrine Carcinoma of Cervix: A Rare Case Report

Neuroendocrine neoplasms (NEN) are derived from endocrine cells and are very rarely seen in gynecological practice. Here we report a case of small cell neuroendocrine carcinoma (SCNEC) of cervix in a 45 year old married female who presented with history of menorrhagia. On gynecological examination, she had bulky uterus with a palpable non tender, hard nodule on posterior wall of cervix. Ultrasonogram of pelvis was reported as bulky ? adenomyotic uterus with 2.7x2.4x1.0cm well defined collection in fundal region of endometrium. She underwent total abdominal hysterectomy for abnormal uterine bleeding. Histopathology with immunohistochemical markers was reported as small cell neuroendocrine carcinoma (SCNEC) of cervix. This case is reported here for its rarity.

8771 The Impact of Social Determinants of Health Delaying Treatment for Women That Undergo Hysterectomy for Abnormal Uterine Bleeding

<h3>Study Objective</h3> 1) Identify the social determinants of health that contribute to delayed treatment for abnormal uterine bleeding (AUB), defined as women presenting with large uteruses at the time of hysterectomy, and patterns of healthcare utilization over a 3-year period and 2) Assess health-related outcomes in women with delayed hysterectomy for AUB. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Single hospital system. <h3>Patients or Participants</h3> 1,361 women who underwent hysterectomy for benign causes of abnormal uterine bleeding over a 3-year period between January 1, 2014, to December 31, 2017. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Women with enlarged uteri ≥ 500 g at time of hysterectomy were more likely to present to the emergency department (10.9% vs. 7.0%, p=0.034) and subspecialty care visits (34.2% vs. 28.0%, p=0.047). There were no differences in generalist gynecological visits among the two groups. Black women disproportionately composed those with enlarged uteri (59.9% vs. 36.1%, p=<0.001). There were no differences identified in age, BMI, socioeconomic status, ethnicity or insurance type. Women who delayed treatment for AUB were more likely to undergo mini-laparotomy (2.7% vs. 0.8%, p=0.01) or laparotomy (68.9% vs. 24.2%, p=<0.001) compared to minimally invasive approaches, demonstrated lower pre-operative hemoglobin levels (11.5 vs. 12.3, p=<0.001), lower hemoglobin levels in a 3-year period leading up to hysterectomy (10.0 vs. 11.3, p=<0.001), increased estimated blood loss (373.3mL vs. 178.7mL, p=<0.001), procedure time (171.9 min vs. 145.1min, p=<0.001) and length of hospital stay (1.4 days vs. 0.6 days, p=<0.001). <h3>Conclusion</h3> Delayed treatment for women who ultimately underwent hysterectomy for abnormal uterine bleeding was associated with increased emergency department and subspecialty care visits, and this population was disproportionately composed of Black woman. Perioperatively, delayed treatment was associated with more open surgeries, increased blood loss, increased operative time, and longer hospital stays.

8412 Effects of the COVID-19 Pandemic on Women Seeking Hysterectomy for Abnormal Uterine Bleeding

<h3>Study Objective</h3> Examine the effects of operating room closures during the COVID-19 pandemic for women undergoing hysterectomy for abnormal uterine bleeding (AUB) in a safety net hospital. <h3>Design</h3> Retrospective cohort analysis. <h3>Setting</h3> Academic County Hospital. <h3>Patients or Participants</h3> All patients 18 years or older undergoing a hysterectomy with the benign gynecology service for AUB from May 2018-December 2019 (pre-pandemic) and April 2020-November 2021 (pandemic) at our hospital. A total of 556 patients met inclusion criteria, 401 prior to, and 155 during the pandemic. <h3>Interventions</h3> Laparoscopic, abdominal, and vaginal hysterectomy. <h3>Measurements and Main Results</h3> Pandemic patients were more likely to have a lower starting Hemoglobin (p <0.05), history of blood transfusion (p <0.05) and a lower Hemoglobin nadir (p < 0.05) than patients prior to the pandemic. They were also more likely to be medically managed while awaiting surgery (p < 0.05). The average wait time between decision for hysterectomy and surgery date pre-pandemic was 30 days compared to 121 days during the pandemic (p < 0.05). While awaiting surgery, pandemic patients were significantly more likely to receive blood transfusions (OR 6.7, 95% CI 3.5, 12.8), return to the clinic (OR 21.1, 95% CI 12.6, 35.1), and be seen in the EC for AUB complaints (OR 6.6, 95% CI 3.8, 11.5) than pre-pandemic patients. When controlling for starting Hemoglobin, history of transfusion, Hemoglobin nadir, and use of medical management, this effect persisted, indicating that the length of time patients waited for surgery was significantly associated with the outcome measures. <h3>Conclusion</h3> Women needing a hysterectomy for AUB in our hospital waited three months longer for surgery during the pandemic compared to prior to the pandemic. Additionally, while awaiting surgery, patients were seen in the EC and office more frequently and required more blood transfusions. The effects of COVID have been far-reaching, and gynecologic care for our patient population has been significantly, negatively impacted.

7369 Conventional Vaginal Hysterectomy vs vNOTES Hysterectomy: A Retrospective Cohort Analysis of Two Techniques

<h3>Study Objective</h3> The aim of this study was to compare the surgical outcomes in women undergoing a vaginal hysterectomy for abnormal uterine bleeding through a conventional vaginal hysterectomy (TVHH) vs. hysterectomy using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) method. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> Tertiary academic center. <h3>Patients or Participants</h3> Seventy-eight patients with the diagnosis of abnormal uterine bleeding underwent a hysterectomy. Forty-five of them had a TVH and thirty-three of them had a hysterectomy via the vNOTES approach. <h3>Interventions</h3> A group of surgeons trained in conventional vaginal hysterectomy and vNOTES hysterectomy performed the surgeries from July 2017 to December 2021. <h3>Measurements and Main Results</h3> Our primary surgical outcomes were surgical time, rate of surgical complication, and blood loss. Average age for patients who underwent TVH was 41 years old and 41.2 for vNOTES; however, the average BMI for TVH was 31.7 and 30.8 for the vNOTES. 17% of the TVH group had a prior cesarean delivery (n=8) and 42.4% of them had a prior cesarean (n=14). The complications in the vNOTES group included three patients that required blood transfusions and one was readmitted within 30 days. All four of these patients had uteri weighing more than 100 g (102-840g) and one had a previous cesarean delivery. For the conventional group, nine cases resulted in complications including three blood transfusions, four patients with postoperative fever, one with a vaginal laceration and one ureteral injury. Three patients had a previous cesarean delivery and only two of them had a uterine larger than 100 g. <h3>Conclusion</h3> Overall vNOTES hysterectomies were faster and had lower complications compared to conventional vaginal hysterectomy; however, our analysis did not reach statistical significance. Patients in the vNOTES group had a higher proportion of prior cesareans and overall larger uteri, although less complications were noted. Randomized clinical trials are required to better characterize the findings of our study.

Morphological Spectrum of Endometrium in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is one of the major problems requiring gynecological consultation. Biopsy proved to be gold standard for the accurate diagnosis of abnormal bleeding. It is more frequently observed in perimenopausal females. Aim: To determine morphological spectrum of endometrium in patients of pre and post-menopausal age groups with abnormal uterine bleeding. Study Design: Descriptive-cross-sectional study Place and duration of study: Department of Histopathology, K. E. Medical University Lahore from 31-07-2018 31-01-2019 Methodology: Three hundred and eighty four patients undergoing diagnostic dilatation and curettage or hysterectomy for abnormal uterine bleeding were included. Their demographic features i-e age and address were noted. The biopsies received in Pathology Department were formalin fixed, after tissue processing and cutting the slides were prepared and stained with haematoxylin and eosin stains. Results: There were 311(80.99%) patients between 25-50 years of age whereas 73(19.01%) between 51-60 years of age. Morphological spectrum of endometrium in patients of pre and post-menopausal age groups with abnormal uterine bleeding shows that 71(18.49%) had proliferative morphology, 58(15.10%) had secretary, 37(9.64%) had simple hyperplasia, 56(14.58%) had complex hyperplasia, 17(4.43%) had atrophic endometrium and 145(37.76%) had other type of morphology (may include mechanical causes such as intrauterine contraceptive device and malignancy). Conclusion: Morphological spectrum of endometrium in patients of pre and postmenopausal age groups with abnormal uterine bleeding shows proliferative morphology as the common morphology followed by secretary, simple hyperplasia, and complex hyperplasia. Key words: Abnormal uterine bleeding, Morphological spectrum of endometrium, Proliferative

Prevalence of adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding, pelvic pain or uterine prolapse – A retrospective cohort study

BackgroundAdenomyosis can cause symptoms like dysmenorrhea, dyspareunia, pelvic pain and bleeding disorders and is related to subfertility and obstetrical complications. The disease is probably underestimated and underdiagnosed because of difficulties in reliable clinical examination and imaging results. The age-related prevalence of adenomyosis still remains unclear. In this retrospective analysis we describe the rate of adenomyosis in two independent cohorts of patients undergoing hysterectomy for benign diseases (2011–2013 and 2015–2018) and its correlation to presurgical symptoms respectively indications for hysterectomy. Materials and methodsAll surgeries have been performed in the same department of minimally invasive gynecological surgery by a total of two experienced surgeons following a surgical internal standard for the indication bleeding disorder, dysmenorrhea. We analyzed the overall rate of patients with adenomyosis in both cohorts and related the histological presence of adenomyosis to presurgical symptoms. We also analyzed a subgroup of postmenopausal patients with uterine prolapse. ResultsIn 307 patients we detected 42.0% of cases with histologically proven adenomyosis. In the group of patients with bleeding disorders and dysmenorrhea as indication for surgery we found the highest rate of adenomyosis (59.3%, cohort 1). 81,1% patients with adenomyosis (cohort 1) reported symptoms. In the subgroup of 42 postmenopausal patients, we found 23.8% of cases with adenomyosis. ConclusionOur data shows that a positive anamnesis regarding the symptoms bleeding disorders and dysmenorrhea is suspicious for adenomyosis. In hysterectomy specimen adenomyosis can be found in more than 40%. The role of adenomyosis-related symptoms requires further investigation, especially in adolescent and postmenopausal patients.

The Role of FIGO PALM-COEIN Classification of the Underlying Causes of Abnormal Uterine Bleeding and Clinicopathological Correlation of Patients Undergoing Hysterectomy in a Tertiary Care Referral Center of Western Rajasthan.

The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has developed a classification system (PALM-COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study the two components of this system in clinical practice in general and establish a clinicopathological correlation of AUB with the context of the PALM component in particular. The data of 158 patients who underwent hysterectomy for abnormal uterine bleeding in 1 year at the tertiary care Centre of western Rajasthan was collected from old case records and analysed. The patients were initially worked up in the outpatient department with the history and clinical examination, followed by transabdominal or transvaginal ultrasonography depending on the uterine size and the pathology. The patients requiring more detailed pictures were advised computed tomography (CT) scan. All the patients were screened for common medical disorders like thyroid disorders, prolactin levels, and blood sugar levels. Thereafter an endometrial biopsy and liquid-based cytology were done for all the patients to rule out malignancy. The relative contribution of various causes of PALM (structural) and COEIN (functional) components and clinicopathological correlation was analysed. PALM and COEIN components contributed almost equally for AUB when assessed clinically. On the other hand, the histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB, i.e., 17.2% versus 82.8 %. AUB-L was the commonest (41.1 %) aetiology overall. The PALM-COEIN classification system should consider both the clinical and histopathological diagnoses in women having AUB. It is concluded that the most common cause of AUB is leiomyoma and the most common age group undergoing hysterectomy is the 4th decade. Although the medical treatment options are there, patients of premenopausal age require hysterectomy who do not benefit from medical regimens.

Tubal interruption and subsequent surgery for pain after endometrial ablation: A retrospective cohort study.

Endometrial ablation (EA) is an alternative to hysterectomy for abnormal uterine bleeding (AUB), with reduced recovery time and fewer operative risks. However, post-ablation pain may be associated with subsequent surgery, including hysterectomy. It is uncertain what factors affect surgery rates for post-ablation pain, particularly with respect to timing and technique of tubal interruption. To evaluate the relationship between tubal interruption and post-ablation pain and subsequent surgery. We conducted a retrospective cohort study involving 324 patients at a Melbourne tertiary hospital from 2009 to 2020. The primary outcome was subsequent pelvic surgery for pain following EA. Pain following EA was reported by 29.7% of patients, with 10.5% of patients undergoing subsequent surgery for pain. Patients with tubal interruption were more likely to undergo subsequent surgery for pain than those with no tubal interruption (odds ratio (OR): 3.49, 95% CI: 1.59-7.66; P=0.002). Tubal ligation was strongly associated with subsequent surgery for pain (OR: 3.12, 95% CI: 1.48-6.57; P=0.003). In contrast, those with salpingectomy did not have an increased risk of subsequent surgery for pain, compared to those with no tubal interruption (OR: 1.5; 95% CI 0.32-7.13). Pre-ablation pain (adjusted OR: 2.98, 95% CI: 1.37-6.48; P=0.006) and previous caesarean section (OR: 2.66; 95% CI: 1.13-6.25; P=0.025) were also associated with subsequent surgery for pain. Our results suggest that tubal interruption, pre-ablation pain and previous caesarean section are associated with subsequent surgery for pain. These results can better inform preoperative counselling regarding the risk of subsequent surgery after EA.

Abnormal uterine bleeding in perimenopausal women: Clinical histopathological and sonography correlation

Patient who underwent hysterectomy for Abnormal Uterine Bleeding their clinical findings were related to sonography and histopathology reports.This is retrospective observational study conducted in obstetric and gynaecology department. Patient who have undergone hysterectomy for AUB, their data retrived from case file and their ultrasonography reports and histopathological examination reports were compared.153 women who have under gone hysterectomy had complaint of menorrhagia and they belong to perimenopausal age group, most of them were between 40-45 years of age. Ultrasonography is suggestive of fibroid in most of the patients and it is most sensitive for diagnosis of uterine fibroid.Fibroid is a most common cause of AUB. Clinical, sonography and histopathological findings correlated well with the diagnosis.

Hysterectomy and Oophorectomy in Reproductive Age: A Cross-Sectional Study from a Tertiary Care Hospital.

IntroductionHysterectomy is a common surgical procedure in women, and oophorectomy may also be performed with the hysterectomy. The objective of this study was to identify clinical indications and pathological findings in hysterectomies, performed for gynecological causes, in women of reproductive age (15-49 years) and to determine if oophorectomy or ovarian conservation was performed with the hysterectomy as well as the pathological findings in the ovaries.MethodsThis cross-sectional study was conducted in the department of Pathology at Dow Medical College in Karachi, Pakistan, from September 2017 to December 2018. Data were recorded from the pathology reports of hysterectomy specimens received in the department. Data of hysterectomies performed for gynecological causes in women of reproductive age group were selected and analyzed, using Microsoft Excel (Microsoft, Redmond, Washington) and SPSS version 20 (IBM Corp., Armonk, New York). Data of women more than 49 years and obstetric hysterectomies were excluded.ResultsThree hundred sixty-one hysterectomies were received; 157 of which were hysterectomies performed in women of reproductive age for gynecological reasons. The mean age of the women was 40.37 (± 5.47) years. Abnormal uterine bleeding was the most frequent clinical indication for hysterectomy in 81 (51.59%) women, followed by uterine prolapse in 29 (18.47%) and leiomyoma in 22 (14.01%). Common pathologies in the endometrium were endometritis in 14 (8.92%) and endometrial polyp in nine (5.73%). In the myometrium, leiomyoma was reported in 52 (33.12%) cases, adenomyosis in 37 (23.57%), and both leiomyoma and adenomyosis in 37 (23.57%) women. Uterine prolapse was histologically identified in 38 (24.20%) women. Oophorectomy was performed on 107 (68.15%) women, and out of these, 83 (77.59%) women's ovaries showed either normal histology or functional cysts. Ovarian pathologies reported were endometriosis, serous cystadenomas and oophoritis in five patients each (4.81%), ovarian serous carcinoma in three (2.88%), and mucinous carcinoma in one (0.96%) patient.ConclusionAbnormal uterine bleeding was the most common clinical indication for hysterectomy in women of reproductive age. The common pathologies in the hysterectomies were endometritis, endometrial polyp, leiomyoma, adenomyosis, and uterine prolapse. Most of the ovaries removed with the hysterectomy did not show any significant pathology, therefore, further studies in this direction are recommended for confirmation of this finding. Ovarian conservation may be considered in women undergoing hysterectomy for abnormal uterine bleeding or other uterine causes and with no radiological or surgical indication for oophorectomy.

Hysteroscopic endometrial resection vs. hysterectomy for abnormal uterine bleeding: impact on quality of life and sexuality. Evidence from a systematic review of randomized controlled trials.

The aim of this systematic review is to summarize the current evidence regarding the effectiveness of hysterectomy and hysteroscopic endometrial resection in improving quality of life (QoL), sexual function and psychological wellbeing of women abnormal uterine bleeding. We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO 2019 CRD42019133632), using the terms 'endometrial ablation', 'endometrial destruction', 'endometrial resection', 'hysterectomy', 'menorrhagia', 'dysfunctional uterine bleeding', 'quality of life', 'sexuality' published up to April 2019. Our literature search produced 159 records. After exclusions, nine studies were included showing the following results: both types of treatment significantly improve QoL and psychological wellbeing; hysterectomy is associated with higher rates of satisfaction; hysterectomy is not associated with a significant deterioration in sexual function. Hysterectomy is currently more advantageous in terms of improving abnormal uterine bleeding and satisfaction rates than hysteroscopic endometrial destruction techniques. Furthermore, there is some evidence of a greater improvement in general health for women undergoing hysterectomy. However, high-quality prospective randomized controlled trials should be implemented to investigate the effectiveness of hysterectomy and endometrial ablation in the improvement of QoL outcomes in larger patient cohorts.

2878 Posterior Approach to Uterine Artery Ligation

Video Objective This video demonstrates an alternative approach to uterine artery ligation during a Robotic Assisted Total Laparoscopic Hysterectomy in the setting of an obliterated anterior cul-de-sac. Setting This a case of a 29 year old with two prior cesarean sections presenting for Robotic Assisted Total Laparoscopic Hysterectomy for abnormal uterine bleeding. Upon entry, the uterus is found to be densely adherent to the anterior abdominal wall. Interventions The uterine arteries were dissected out, desiccated, and transected from the posterior aspect of the uterus due to the limited access anteriorly secondary to bladder adhesions. Conclusion In conclusion, an obliterated anterior cul-de-sac due to previous surgeries makes it difficult to access the uterine arteries secondary to poor visualization. By approaching uterine artery ligation from the posterior aspect, one may avoid inadvertent injury to vasculature or the bladder and reduce the amount of bleeding during the bladder dissection.

Effect of Age and Prior Gynecologic Surgery on Pathologic Diagnosis in Patients Undergoing Benign Hysterectomy

Study Objective To understand the influence of age and prior uterine surgery on postoperative pathologic diagnosis at the time of benign hysterectomy. Design Retrospective cohort study. Setting Single academic hospital. Patients or Participants Patients undergoing hysterectomy for abnormal uterine bleeding or fibroids from 2012 to 2016. Interventions Hysterectomy performed by a minimally invasive gynecologic surgeon. Measurements and Main Results We identified 570 patients with a preoperative diagnosis of abnormal uterine bleeding or fibroids who underwent hysterectomy from 2012-2016. When stratified by age, there were no differences in BMI, parity or history of cesarean sections between the groups. Younger women (≤35) were more likely to have a preoperative diagnosis of pelvic pain, dysmenorrhea and a history of endometriosis (p Conclusion Women under the age of 35 are more likely to have benign pathology at the time of hysterectomy for abnormal bleeding despite higher rates of pelvic pain, dysmenorrhea and preoperative medical management. Gynecologic surgery does not increase the risk of adenomyosis or fibroids at the time of hysterectomy.

Patient-reported lower urinary tract symptoms after hysterectomy or hysteroscopy: a study from the Swedish Quality Register for Gynecological Surgery

Introduction and hypothesisHysterectomy is sometimes considered the cause of lower urinary tract symptoms (LUTS). We hypothesized that hysterectomy for abnormal uterine bleeding and/or symptoms of fibroids is more likely to cause LUTS than a hysteroscopic procedure for the same indications.MethodsTwo groups of women were compared: one group comprised 3,618 women who had had a hysterectomy due to abnormal uterine bleeding or symptoms of fibroids and the other group comprised 238 women who had had hysteroscopic treatment for the same indications. The main outcome measures were occurrence of LUTS before and 1 year after the surgical intervention. The frequencies of LUTS before and after surgery were compared between the groups. Binary logistic regression was used to model the odds of having postoperative urinary leakage and urgency while controlling for uterine size, surgical procedure and preoperative LUTS.ResultsThere were no statistically significant differences between women after hysterectomy and after hysteroscopy in the frequencies of LUTS before or after surgery, when uterine size was comparable. However, there was a difference in the rates of de novo urinary incontinence between women with hysterectomy and women with hysteroscopy (7.6%, 95% CI 6.3–9.0, and 3.2%, 95% CI 1.6–6.5, respectively). Of the women with a large uterus, 58.6% (95% CI 51.5–65.5) reported relief of urinary incontinence and 85.5% (95% CI 82.3–88.4) reported relief of urinary urgency postoperatively.ConclusionsOur results suggest that it is important to individualize preoperative information in women prior to hysterectomy since the outcome concerning LUTS depends on preoperative symptoms and uterine size.

A clinicopathological study of correlation of clinical, sonological and histopathological findings following hysterectomy for abnormal uterine bleeding based on PALM-COEIN Classification

Background: To identify the proportion of different causes of Abnormal Uterine Bleeding in women undergoing hysterectomy according to the PALM COEIN classification proposed by FIGO. Methods: Collection of data was done from the medical records of women who underwent hysterectomy for Abnormal Uterine Bleeding in the study period from January 2015 to June 2016. Women who underwent planned abdominal hysterectomy and laparoscopy assisted vaginal hysterectomy for Abnormal Uterine Bleeding were included in the study. The clinical, sonological and histopathologic findings were analyzed so as to identify the proportion of different causes of Abnormal Uterine Bleeding in women undergoing hysterectomy. Causes of Abnormal Uterine Bleeding were categorized by calculating the percentage according to the PALM-COEIN classification. Results: A total of 214 women with Abnormal Uterine Bleeding underwent hysterectomy out of which 148 had planned abdominal hysterectomy and 66 had planned laparoscopy assisted vaginal hysterectomy, in the study period. AUB-L was the commonest histopathology (38.3%cases) followed by AUB-O(22%cases) and about 21.5% had adenomyosis. Heavy menstrual bleeding was the commonest presenting symptom (24.3% cases) while 40% and 36% had irregular and frequent menstrual bleeding respectively. Conclusion: FIGO has proposed this new standardized terminology to provide uniform conduct of research as data could be compared both nationally and internationally without any confusion and classify the causes of Abnormal Uterine Bleeding according to PALMCOEIN and identify the relative proportions of each cause. This will help in further research for comparative and epidemiological studies in various populations. More research is needed to identify the riskfactors for leiomyoma in our region as it more prevalent here.