Hysterectomy For Benign Gynecologic Disease Research Articles

Hysterectomy with bilateral salpingo-oophorectomy: a survey of gynecological practice.

Oophorectomy at the time of hysterectomy can be carried out by open and minimally invasive methods. The objective of this survey was to determine the current operative practice concerning oophorectomy at hysterectomy for benign gynecological disease in the UK, and to establish practitioners' views regarding the desirability of a randomized controlled clinical trial to compare various operative techniques for this procedure. Gynecologists associated with the British Society of Gynecological Endoscopy. A self-administered structured questionnaire was posted to 323 UK gynecologists to enquire about their surgical practice in performing oophorectomy at hysterectomy and their willingness to participate in a randomized trial. The postal questionnaire was returned by 147 (46% response rate). For performing oophorectomy at hysterectomy, 84 (57%) routinely used laparotomy only. However, 67 (46%) in total were competent in all surgical methods i.e. laparotomy, vaginal and laparoscopical. Of these, 38 (57%) were willing to enter patients into a proposed clinical trial comparing vaginal and laparoscopically assisted oophorectomy at hysterectomy. The current surgical approach to performing oophorectomy at hysterectomy varies widely. This suggests that opinion regarding the relative roles of abdominal, vaginal and laparoscopic methods is divided. Hence, a rigorous randomized trial comparing the efficacy and safety of these methods is practicable and urgently needed.

Perioperative morbidity of hysterectomy for benign gynaecological disease

This study reviews the perioperative surgical and associated morbidity of abdominal and vaginal hysterectomy for benign gynaecological disease. Over a 5-year period, 199296, there were 2088 hysterectomies; 1244 (60%) abdominal and 844 (40%) vaginal. The surgical morbidity for abdominal hysterectomy (6·2%) was twice that of vaginal hysterectomy (3·2%). The associated morbidity for abdominal hysterectomy (4·0%) was four times that of vaginal hysterectomy (0·9%). Additional surgical procedures (other than salpingo-oophorectomy) performed at the time of hysterectomy increased morbidity by 20% in association with abdominal hysterectomy and by 46% with vaginal hysterectomy. Serious morbidity associated with hysterectomy for benign disease was low.

Surgical morbidity of hysterectomy for benign gynecologic disease

Objective: To assess the surgical morbidity associated with abdominal and vaginal hysterectomy for benign gynecologic disease.Methods: Over a 5-year period in one gynecology unit with 10 surgeons, perioperative complications associated with abdominal and vaginal hysterectomy for benign gynecologic disease were reviewed. Surgical morbidity included inadvertent cystotomy, ureteric trauma, vesicovaginal fistula, bowel trauma, hemorrhage → OR, blood transfusion, hematoma, and reoperation. Associated surgical morbidity included infection, bowel ileus/obstruction, thromboembolism, readmission, and admission to the ICU.Results: For the 5 years (1992–1996), there were 2,088 hysterectomies: 1,244 (60%) abdominal and 844 (40%) vaginal.Conclusions: The overall morbidity associated with hysterectomy for benign disease is low. These figures have been further refined to delineate the complications of additional operative procedures performed at the time of hysterectomy. Overall, additional procedures increased morbidity by 20% in association with abdominal hysterectomy and by 46% with vaginal hysterectomy. In addition, a profile can be provided for each surgeon. Morbidity (%)SurgicalAssociatedTotalAbdominal6.24.010.2Vaginal3.20.94.1

Laparoscopic and abdominal hysterectomy: a cost comparison

To compare the cost of laparoscopically assisted vaginal hysterectomy (LAVH) with that of total abdominal hysterectomy (TAH) under casemix. Retrospective comparison of the costs, operating time and length of hospital stay. The 16 women undergoing consecutive LAVH and 16 age-matched women undergoing TAH between 1 February 1994 and 31 July 1995; all women were public patients undergoing hysterectomy for benign disease. Monash Medical Centre, a large tertiary teaching hospital in Melbourne, Australia, where casemix is used to determine funding and budget allocation. The difference between the costs of the two procedures was not statistically significant (P = 0.5), despite the cost of laparoscopic hysterectomy including that of disposables. The mean operating time for TAH was 86 minutes (95% CI, 65.5-106.5), compared with 120 minutes (95% CI, 100.8-140.5) for LAVH (P < 0.01). The mean length of stay in the TAH group was 5.75 days, compared with 3.25 days in the LAVH group (P < 0.001). In hysterectomy for benign gynaecological disease, the laparoscopic procedure costs the same as the total abdominal procedure. Audit such as this is important in patient management and in guiding hospitals in funding and bed allocation.

Pap Smears After Hysterectomy: Pearce KF, Haefner HK, Sarwar SF, Nolan TE. Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996;335:1559-62

Pap Smears After Hysterectomy: Pearce KF, Haefner HK, Sarwar SF, Nolan TE. Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996;335:1559-62

Pap Smears After Hysterectomy: Pearce KF, Haefner HK, Sarwar SF, Nolan TE. Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996;335:1559-62

Pap Smears After Hysterectomy: Pearce KF, Haefner HK, Sarwar SF, Nolan TE. Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996;335:1559-62

Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease.

Periodic, routine Papanicolaou smears of cells from the vagina are commonly examined in women who have undergone a hysterectomy for benign gynecologic disease. The benefits of this method of screening are not known. We analyzed Papanicolaou smears obtained from the vaginal apex (cuff) in 6265 women at Charity Hospital in New Orleans between January 1, 1992, and December 31, 1994. Of the 10,595 vaginal smears, an estimated 9610 were obtained during follow-up examinations of 5682 women who had undergone hysterectomy for benign gynecologic disease. Among these 9610 vaginal smears, 104, from 79 women, were abnormal. The abnormal smears were categorized according to the findings, as follows: atypical squamous cells of undetermined significance, 52 (0.5 percent of all smears); low-grade squamous intraepithelial lesion, 44 (0.5 percent); high-grade squamous intraepithelial lesion, 6 (0.1 percent); and squamous-cell carcinoma, 2 (0.02 percent). In five women, biopsies revealed vaginal intraepithelial neoplasia type I or II; there were no biopsy-proved cases of vaginal cancer. The probability of an abnormal Papanicolaou smear in this group of women was 1.1 percent, and the positive predictive value of the Papanicolaou test for detecting vaginal cancer was 0 percent (95 percent confidence interval, 0 to 33 percent). The prevalence of abnormal findings on cytopathological examination of vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease is extremely low.

Changes in the function of the lower urinary tract after hysterectomy

The relationship between the performance of hysterectomy and the function of the lower urinary tract is assessed on the basis of epidemiological and urodynamic studies. Urinary symptoms develop, but also disappear, after hysterectomy. The postoperative prevalence of urinary symptoms is for the major part determined by the preoperative prevalence, which is statistically significantly higher compared to the prevalence of urinary symptoms in the normal population. Apparently, women scheduled for hysterectomy for benign gynecological disease, are somehow different from women not undergoing hysterectomy. However, urodynamic investigations do not show what the difference is. From urodynamic analysis it becomes apparent that hysterectomy causes temporary interruption of bladder function due to surgical injury of the bladder wall. Except for this finding, urodynamic studies show that postoperative lower urinary tract function is essentially determined by preoperative function. Bladder and urethral dysfunction is only likely to develop when the surgical procedure is extended into the paravaginal tissues or when the pelvic plexus is located in the field of normal surgical dissection.

Laparoscopic-Assisted Vaginal Hysterectomy, Bilateral Salpingo-Oophorectomy, and Pelvic Lymph Node Sampling for Endometrial Cancer

The use of laparoscopic-assisted vaginal hysterectomy has gained in popularity among gynecologic surgeons and is thought at present to be useful in converting a hysterectomy from an abdominal to a vaginal approach. The staging of endometrial cancer requires peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling. This surgical staging requires a laparotomy incision, with a resulting minimum hospital stay of 3–5 days. In an effort to decrease the morbidity associated with this procedure, we report the use of laparoscopic surgery to assist with collection of peritoneal cytology, vaginal hysterectomy, ovarian removal, and pelvic node sampling. The potential usefulness and limitations of this technique are discussed. The role of laparoscopic-assisted hysterectomy for benign gynecologic disease and for endometrial cancer is in the formative stage. (J GYNECOL SURG 8:91, 1992)

Psychosexual functioning after treatment for cancer of the cervix: a comparative and longitudinal study

Twenty-six couples participated in a 2-year longitudinal study of sexual functioning before and after treatment for carcinoma of the cervix. Sexual functioning was measured on admission prior to their treatment and at 6, 12 and 24 months follow-up and made operational in terms of current sexual behavior, sexual motivation, sexual (dis)satisfaction, and the perception of genital sensations of sexual arousal. An age-matched nonpatient control group was added to the study. In addition, the results of a 1-year longitudinal assessment of sexual functioning of women diagnosed and treated by means of simple hysterectomy for benign gynecologic disease were used for comparison. The impact of physical variables and participation in the research project was also evaluated. At 1-year follow-up, sexual functioning of the women who had been treated for carcinoma of the cervix was very similar to sexual functioning of the women who underwent simple hysterectomy for benign disease: in both populations the sexual response was significantly disturbed, whereas current sexual behavior and motivation for sexual interaction were within the normal range. The women clearly expressed general satisfaction with their sexual functioning and little relational sexual dissatisfaction. These data demonstrate that woman's motivation for and satisfaction with sexual interaction with the partner is not limited to the experience of sexual arousal and that sexual rehabilitation aimed specifically at the diagnosis of cancer and the associated physical variables is not really justified.

Unrecognized small vesicovaginal fistula as a cause of persistent urinary incontinence

Three cases of persistent urinary incontinence from unrecognized small vesicovaginal fistula after abdominal hysterectomy for benign gynecologic disease are presented. Visualization of urine in the posterior fornix was suggestive; diagnosis was confirmed by methylene blue test and cystoscopy. Two patients had undergone interval Marshall-Marchetti-Krantz operations for suspected stress-related urinary incontinence. An extensive literature survey confirms that the vesicovaginal fistula were an unlikely complication of the Marshall-Marchetti-Krantz procedure.

Reduction of the stretch modulus of human cervical tissue by prostaglandin E2

Samples of cervical tissue were obtained from women immediately following term delivery from spontaneous labor or oral PGE2-induced labor and from a small number of nonpregnant women in the reproductive years undergoing hysterectomy for benign gynecologic disease. The measured strips were placed in a well-oxygenated bath at 37°C. containing Ringer's solution and stretched at a constant rate while continuously recording length and tension. The data were converted to stress-strain diagrams. Each curve contained a long linear portion which allowed one to compute a stretch modulus for each sample. A total of 71 strips from 23 patients was used. The average stretch modulus from the oral PGE2-induced patients was significantly lower than the spontaneous labor group (p < 0.005), which, in turn, was significantly lower than the stretch modulus of the nonpregnant cervical tissue. It was also noted that the yield point was lower in the PGE2 series when compared to the spontaneous labor series (p < 0.05). The effect of the PGE2 at a bath concentration of 10−5 to 10−6 Gm. per cubic centimeter was to materially reduce the stretch modulus within 5 to 15 minutes of the drug addition in both the PGE2-induced and spontaneous labor series. The results of these experiments indicate that PGE2 has the effect of reducing cervical stiffness.