Total Hysterectomy For Benign Disease Research Articles

Post-traumatic stress following total hysterectomy for benign disease: an observational prospective study

Purpose Over the last decade, there has been growing interest in the psychophysical integrity of surgical patients in the context of healthcare events. In the present study, we aimed to evaluate the incidence rate of postoperative distress symptoms, namely post-traumatic stress disorder (PTSD), following total hysterectomy for benign disease. We also investigated possible associations between sociodemographic characteristics, clinical outcomes, anxiety, depression, and PTSD. Methods We prospectively enrolled 100 consecutive patients who underwent total hysterectomy for benign disease between 01/01/2019 and 15/04/2019. Demographic and surgical-related characteristics have been registered. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered preoperatively (Time1), postoperatively (Time2), and at follow-up clinical evaluation, between two and three months after surgery (Time3). PTSD was defined based on the results of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at Time3. Results At Time3, the median PCL-5 score was 12,8 (0–70), and 16.4% of patients had PTSD symptoms (PCL-5 > 33). No correlation between sociodemographic or gynecologic characteristics and PTSD was detected. A significant association between depression (HADS > 8) at Time2 (p = 0.002) and Time3 (p < 0.001) and PTSD symptoms was shown. Conclusion Hysterectomy for benign disease is associated with a non-negligible risk of PTDS; the use of the HADS questionnaires might be useful to select patients who might benefit from dedicated psychological support.

Choosing Wisely® in Preventive Medicine: The American College of Preventive Medicine's Top 5 List of Recommendations.

The Choosing Wisely(®) initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM's recommendations with the intention of facilitating wise decisions about the appropriate use of preventive care. After utilizing an iterative process that involved reviewing evidence-based literature, the ACPM Choosing Wisely Task Force developed five recommendations targeted toward overused services within the field of preventive medicine. These include: (1) don't take a multivitamin, vitamin E, or beta carotene to prevent cardiovascular disease or cancer; (2) don't routinely perform prostate-specific antigen-based screening for prostate cancer; (3) don't use whole-body scans for early tumor detection in asymptomatic patients; (4) don't use expensive medications when an equally effective and lower-cost medication is available; and (5) don't perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease. The Task Force also reviewed some of the barriers to implementing these recommendations, taking into account the interplay between system and environmental characteristics, and identified specific strategies necessary for timely utilization of these recommendations.

A Common Clinical Dilemma: Management of Abnormal Vaginal Cytology and Human Papillomavirus Test Results.

Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (HPV) tests, and clinicians are faced with managing their abnormal results. Our objectives were to review the literature on vaginal cytology and high-risk HPV (hrHPV) testing and to develop guidance for the management of abnormal vaginal screening tests. An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that (1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and (2) in women for whom surveillance is recommended, e.g., women posttreatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors. Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.

Racial Disparities among Women Undergoing Laparoscopic or Robotic Total Hysterectomy for Benign Disease

Racial Disparities among Women Undergoing Laparoscopic or Robotic Total Hysterectomy for Benign Disease

Vaginal Hysterectomy Compared Hysterectomy Abdominal in Women without Genital Prolapse

To compare intraoperative and postoperative outcomes of vaginal hysterectomy with those of abdominal hysterectomy in women without genital prolapse or adnexal pathology. A randomized clinical trial, open, prospective, observational study was conducted,with 35 patients without genital prolapse scheduled for total hysterectomy for benign disease. University hospital. Patients were randomly assigned to vaginal hysterectomy (19 patients) or abdominal hysterectomy (16 patients). Main Outcome measures included estimated blood loss, duration of surgery, postoperative pain (intensity and analgesic requirements), time in hospital, postoperative complications, recovery time and patient satisfaction. Statistical analysis was performed using c2 and Fisher exact. Mann-Whitney test at 5% level of significance. The patients underwent vaginal hysterectomy and abdominal according to random assignment, acting the same team of doctors. Estimated blood loss were significantly lower in vaginal hysterectomy (median 520 ml) than in the abdominal hysterectomy (median 902 ml). Duration of surgery was similar (median of 55 min in both groups). Postoperative pain measured by visual analog scale and analgesic requirement was lower for vaginal hysterectomy than for abdominal hysterectomy. In one case of infection in each group. Postoperative hospital stay was lower in the vaginal group. The recovery time was significantly shorter in the vaginal group (median 15 days) versus abdominal group (median 35 days). In general, patients satisfaction with the operation was similar in both groups. Patients without prolapse underwent vaginal hysterectomy for the treatment of benign diseases had some advantages over those undergoing abdominal hysterectomy less intraoperative blood loss, less postoperative pain and faster recovery. Vaginal hysterectomy may be replaced abdominal hysterectomy in most patients requiring hysterectomy.

Laparoscopic Total Hysterectomy Versus Robotic Total Hysterectomy for Benign Disease: A Retrospective Comparison of Hospital Costs

Laparoscopic Total Hysterectomy Versus Robotic Total Hysterectomy for Benign Disease: A Retrospective Comparison of Hospital Costs

Cost-Effectiveness of Pap Smear Screening for Vaginal Cancer After Total Hysterectomy for Benign Disease

Obstetrical & Gynecological Survey: November 2003 - Volume 58 - Issue 11 - p 725-726 doi: 10.1097/01.OGX.0000093675.28158.4A

Cost-Effectiveness of Pap Smear Screening for Vaginal Cancer After Total Hysterectomy for Benign Disease

To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease. Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy. Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening. Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not cost effective.

Effectiveness of Vaginal Papanicolaou Smear Screening After Total Hysterectomy for Benign Disease

Using literature review, we assessed (1) Papanicolaou smear screening recommendations after hysterectomy for benign disease, (2) total hysterectomy for benign disease as a risk for vaginal dysplasia or carcinoma, and (3) effectiveness of screening for vaginal carcinoma after total hysterectomy for benign disease. We considered (1) organizations' recommendations about screening, (2) references from major textbooks of gynecology, and (3) MEDLINE searches of English-language studies published from 1966 through 1995 using the search strategy (hysterectomy and vaginal smears) or (vaginal smears and vaginal neoplasms). Published or verbal confirmations of screening recommendations were eligible. Criteria for assessing risk of vaginal dysplasia or carcinoma included original research, documented reports of hysterectomy as an exposure, and evidence of preinvasive vaginal disease or vaginal carcinoma outcomes. We sought data assessing burden of suffering, screening efficacy, and effectiveness of early detection. Descriptive and analytic data from each study were abstracted. Screening recommendations were categorized by the organizations' positions: two opposed screening, two supported screening, and six lacked specific guidelines. Data on the risk between total hysterectomy for benign disease and subsequent vaginal carcinoma were organized by study design (three case control, two cohort, and 13 case series) and described. Data on screening effectiveness were organized to address the criteria advocated by the US Preventive Services Task Force. There are conflicting guidelines on screening after hysterectomy and conflicting data on the risk of vaginal carcinoma after total hysterectomy for benign disease, though the best-designed research suggests no association. There is insufficient evidence to recommend routine vaginal smear screening in women after total hysterectomy for benign disease.

Effectiveness of vaginal Papanicolaou smear screening after total hysterectomy for benign disease

Effectiveness of vaginal Papanicolaou smear screening after total hysterectomy for benign disease

At a glance..: one-minute abstracts of the current literature on cancer...

CA: A Cancer Journal for CliniciansVolume 5, Issue 2 p. 45-52 At a GlanceFree Access At a glance…: One-minute abstracts of the current literature on cancer… First published: March 1955 https://doi.org/10.3322/canjclin.5.2.45AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References Macklin, M. T.: Etiologic factors in carcinoma of the uterus, especially the cervix. J. Internat. Coll. Surgeons 21: 365– 378, Mar., 1954. Corscaden, J. A., and Tovell, H. M. M.: The management of carcinoma of the corpus. Am. J. Obst. & Gynec. 68: 737– 756; disc. 756–760, Sept., 1954. Kimbrough, R. A., Jr.: Therapy of carcinoma of the cervix uteri. Pennsylvania M. J. 57: 732– 734, Aug., 1954. Nieburgs, H. E.: The effect of excessive doses of diethylstilbestrol on carcinoma of the cervix. Obst. & Gynec. 2: 213– 229, Sept., 1953. Newton, M.: Carcinoma of the cervix; use of matched pairs of cases to compare treatment by surgery or radiation. Surg., Gynec. & Obst., 99: 29– 33, July, 1954. Novak, E. R.: Radioresistant cervical cancer. Obst. & Gynec. 4: 251– 259, Sept., 1954. Wall, J. A.; Fletcher, G. H., and MacDonald, E. J.: Endometrial biopsy as a standard diagnostic technique; a review of 445 cases. Am. J. Roentgenol. 71: 95– 101, Jan., 1954. Dalali, S. J.; Plentl, A. A., and Bachman, A. L.: The application of pelvic venography to diagnostic problems associated with cancer of the female genital tract. Surg., Gynec. & Obst. 98: 735– 742, June, 1954. Strand, C. M., and Wheelock, M. C.: Ratio of cervical carcinoma to corpus carcinoma. Obst. & Gynec. 4: 380– 382, Oct., 1954. Stern, E., and Menoher, N. P.: Cytologic detection of uterine cancer; in a cancer detection clinic. J. Am. M. Women's A. 9: 343– 349, Nov., 1954. Gustafson, G. W.; Gardiner, S. H., and Stout, F. E.: Ovarian tumors complicating pregnancy; a review of 45 surgically proved cases. Am. J. Obst. & Gynec. 67:1210–1220; disc. 1220–1223, June, 1954. Huey, T. W. Jr.,; Large, H. L., Jr., and Kimmelstiel, P.: Preinvasive carcinoma of the cervix; correlation of findings in biopsy and hysterectomy specimens. Am. J. Obst. & Gynec. 68: 761– 768, Sept., 1954. Wesley, R. H.: A study of cervices removed at total hysterectomy for benign disease. Am. J. Obst. & Gynec. 67: 293– 296, Feb., 1954. Palmer, J. P., and Biback S. M.: Primary cancer of the vagina. Am. J. Obst. & Gynec. 67: 377– 397, Feb., 1954. Martin, P. L.; Slate, T. A., and Merritt, J. W.: Cytologic detection of cervical cancer; four yearS' experience with routine smear examination in private practice. California Med. 79: 108– 111, Aug., 1953. Schmitz, H. E., and Gajewski, C. J.: Management of carcinoma of the uterus. S. Clin. North America 33: 259– 268, Feb., 1953. Kelley, A. J., and Brawner, D. L.: Experience of the Savannah Tumor Clinic in carcinoma of the stump of the cervix. Am. J. Obst. & Gynec. 66:711–715; disc. 715–717, Oct., 1953. Scheffey, L. C.: The delay period in the diagnosis of pelvic malignancy. Obst. & Gynec. 1: 554– 563, May, 1953. Flowers, C. E., Jr.: Delay in treatment of carcinoma of the cervix. Bull. Univ. North Carolina School Med. 2: 12– 14, Oct., 1954. Pearse, W. H., and Behrman, S. J.: Carcinoma of the ovary. Obst. & Gynec. 3: 32– 45, Jan., 1954. Volume5, Issue2March 1955Pages 45-52 ReferencesRelatedInformation

A study of cervices removed at total hysterectomy for benign disease

1.1. The cervices removed in 800 total abdominal hysterectomies for benign disease have been examined.2.2. It was found that 63.6 per cent of these cervices were diseased at the time of removal.3.3. Since a diseased cervical stump can produce serious pelvic symptoms, and since a large number of cervices are diseased at the time of hysterectomy, it is our contention that, even apart from the danger of carcinoma, subtotal hysterectomy should rarely be performed.