Vaginal Hysterectomy For Benign Indications Research Articles

The impact of a previous cesarean section on the risk of perioperative and postoperative complications during vaginal hysterectomy.

To investigate whether a previous cesarean section increases the risk of perioperative and postoperative complications during vaginal hysterectomy. A retrospective cohort study of women who had undergone a vaginal hysterectomy for benign indications between 2014 and 2019 was conducted, comparing patients with or without a previous cesarean section. Perioperative and postoperative complications during vaginal hysterectomy were assessed according to the Clavien-Dindo classification system within 30 days of surgery. Duration of surgery, estimated blood loss, and postoperative hospitalization days were also recorded. A two-sided P value of less than 0.05 was considered significant. A total of 185 women were included, 25 (13.5%) patients had undergone a previous cesarean section (study group) and 160 (86.5%) had no history of cesarean section (comparison group). We found no significant differences in demographic and clinical characteristics as well as postoperative complications and interventions, duration of surgery, estimated blood loss, and postoperative hospitalization days (P > 0.05). However, patients who underwent two or more cesarean sections had a significantly (P = 0.01) higher rate and grade of complications during vaginal hysterectomy, compared with women with only one previous cesarean section. All women who underwent two or more cesarean sections had mild complications during vaginal hysterectomy (40% grade I and 60% grade II, P = 0.01). Vaginal hysterectomy is a safe procedure with few severe complications, regardless of a previous cesarean section. More than one previous cesarean section may increase the risk of minor complications during a vaginal hysterectomy. Patients who underwent a previous cesarean section could be reassured that they do not face an increased risk of complications during a vaginal hysterectomy.

Evaluation of 436 Cases of Vaginal Hysterectomy for Benign Indications - Experience from a Tertiary Hospital

Evaluation of 436 Cases of Vaginal Hysterectomy for Benign Indications - Experience from a Tertiary Hospital

Comparison of conventional heaney technique and ten step vaginal hysterectomy technique

Aim: This study aimed to compare the conventional Heaney technique and the ten-step vaginal hysterectomy technique. Materials and Methods: This retrospective study included 65 women who were operated vaginal hysterectomies at Kanuni Sultan Suleyman Training and Research Hospital between 1 October 2020 and 31 December 2021. Female patients aged between 40 and 85 who underwent vaginal hysterectomy for benign indications were enclosed in the study. They were divided into two groups, Conventional Heaney’s technique(CHVH Group 1) and the ten-step vaginal hysterectomy technique (TSVH Group 2). İn the CHVH group, 39 were potentially eligible and 35 were included in the study. On the other hand, in the TSVH group, 33 were potentially eligible and 30 were included in the study. Results: There were 8(22.85%) complications in the CHVH group and 4(13.33%) in the TSVH group. With the CHVH method, there were 2(5.71%) bladder perforations, 1(2.85%) converted to laparotomy, and 1(2.85%) laparotomy problem. In the TSVH approach, there was no bladder perforation, and no one converted to laparotomy. The group patients' operating times were longer in the CHVH method than in the TSVH technique, 56.6018.44 and 42.2018.63, respectively. Prolapsus uteri were the most common indication for surgery in both groups. Conclusion: TSVH is superior to CHVH in terms of complication, and operating time, The ten-step vaginal hysterectomy technique can be used because of its low complication rates.

Vaginal Hysterectomy Performed Under General Versus Neuraxial Regional Anesthesia: Comparison of Patient Characteristics and 30-Day Outcomes Using Propensity Score–Matched Cohorts

Compared with surgery under general anesthesia (GA), surgery under neuraxial regional anesthesia (RA) has been associated with economic and clinical benefits in certain populations. Our aim was to compare preoperative and postoperative characteristics and 30-day outcomes, including intraoperative complications, for patients undergoing benign vaginal hysterectomy under GA versus RA.This is a retrospective cohort study of patients who underwent vaginal hysterectomy for benign indications between 2015 and 2019 using the American College of Surgeons National Surgical Quality Improvement Program database. Patients were identified using Current Procedural Terminology codes and stratified into GA and RA groups. Propensity score matching was performed to account for selection bias between anesthesia groups.Of 18,030 vaginal hysterectomies performed during this study period, 17,472 (96.9%) were performed under GA and 558 (3.1%) under RA. The RA group was older, more likely to be White, and more likely to have a history of chronic obstructive pulmonary disease and chronic steroid use (P < 0.01 for all); they were less likely to be discharged the same day (8.6% vs 12.2%, P = 0.01). In the matched cohort, there were similar proportions of major, minor, and composite complications between RA and GA groups (major: odds ratio [OR], 0.95; 95% confidence interval [CI], 0.51-1.78; minor: OR, 1.18; 95% CI, 0.74-1.88; composite: OR, 1.10; 95% CI, 0.75-1.64). Similar proportions of same-day discharge were observed (OR, 0.72; 95% CI, 0.47-1.10).Although RA comprises only 3% of the anesthetic modalities used for benign vaginal hysterectomies, it is associated with a similar incidence of postoperative complications compared with general anesthesia.

Pelvic organ prolapse after laparoscopic hysterectomy compared with vaginal hysterectomy: the POP-UP study

Introduction and hypothesisThe objective was to review the long-term prevalence of pelvic organ prolapse (POP) after laparoscopic hysterectomy (LH) compared with vaginal hysterectomy (VH).MethodsAn observational cohort study was conducted amongst women who underwent an LH or a VH for benign indications during the period 1996–2004: the POP-UP study. The prevalence of POP was inventoried by a questionnaire involving the Pelvic Floor Distress Inventory (PFDI-20) and a pelvic floor examination (POP-Q). Women were divided into groups based on route and indication of hysterectomy: LH, VH-1 (for nonprolapse), and VH-2 (prolapse).ResultsFour hundred and six of the 706 eligible patients (58%) returned the questionnaire and 247 underwent POP-Q examination. Sixty-eight patients (17%) received treatment for prolapse; 8% LH, 10% VH-1, and 29% VH-2 (Chi-squared test, p < 0.001). The prevalence of vaginal vault prolapse (apical surgery or ≥ stage 2 at POP-Q) was 4.4% for LH and 5.8% for VH-1 (p = 0.707); and 23% for VH-2 (VH-2 versus others, p < 0.0001). The prevalence of prolapse ≥ stage 2 in any compartment was 62% (n = 153) in total and in 42% of the LH group, 51% of the VH-1 group, and 84% of the VH-2 group (Chi-squared test, p < 0.001). A symptomatic POP (anatomical POP ≥ stage 2 with bulging) was present in 11% of the population.ConclusionsNo difference was found in the prevalence of POP between LH and VH for nonprolapse indications. However, POP after VH for prolapse occurs more frequently than after hysterectomy for other indications.

The role of transforming growth factor-ß (TGF-ß1) in postmenopausal women with pelvic organ prolapse: An immunohistochemical study.

ObjectiveAim of the study was to investigate the expression of transforming growth factor-β1 (TGF-β1), a key regulator of the extracellular matrix composition, in the uterosacral ligaments (USLs) of women with pelvic organ prolapse (POP) compared with controls. We hypothesized that the expression pattern of TGF-β1 differs between postmenopausal women with or without POP.MethodsUnder ethical approval, USL samples were obtained from postmenopausal women undergoing vaginal hysterectomy for stage two or greater pelvic organ prolapse (cases, n = 70) and from postmenopausal women without pelvic organ prolapse undergoing vaginal hysterectomy for benign indications (controls, n = 30). Immunohistochemical staining was performed from paraffin embedded tissue using anti-TGF-β1 antibodies. The expression of TGF-β1 was evaluated by the pathologist, who was blinded to all clinical data.ResultsThe expression of TGF-ß1 was similar in patients with symptomatic POP (89 % positive) and in controls (90 % positive) without any signs of prolapse (p = 0.091). Age-adjusted analysis did not significantly alter these results. Regarding POP-Q stages, TGF-ß1 was significantly more frequently expressed in severe prolapse cases compared to moderate/mild cases (POP-Q stage IV versus POP-Q stage II and III; p = 0.001). No significant association could be detected between TGF-ß1 expression and age, BMI and parity in cases with POP (p > 0.05). As published previously, advanced patients’ age as well as early menopausal age remained independent risk factors associated with POP in multiple logistic regression analysis (p = 0.001; p = 0.02).ConclusionAlthough our study detected POP-Q stage related alterations in USL composition and TGF-ß1 expression, there was no significant difference in the expression of TGF-β1 in cases with or without prolapse.

Comparison of 30-Day Complication Rate Between Minimally Invasive Hysterectomy with and Without Concomitant Urogynecologic Procedure

Study Objective Primary objective was to evaluate risk of perioperative complications when performing concomitant urogynecologic surgery at time of minimally invasive hysterectomy for large uterus (>250gm). Design Retrospective cohort study of existing national database. Patients were followed for complications 30 days after hysterectomy. Setting Data was extracted from the NSQIP database. Patients or Participants Patients were included who underwent laparoscopic or vaginal hysterectomy for benign indications with uterine weight of at least 250gm from 2014-2017. Patients with gynecologic malignancy and those who underwent abdominal hysterectomy were excluded. The total cohort included 7,428 patients. Interventions We assessed the effect of concomitant urogynecologic procedure on 30 day complication rates after laparoscopic or vaginal hysterectomy for large uterus (>250gm). Measurements and Main Results Chi-square analysis and Student's t-test were used to describe the population and compare groups. Primary outcome was composite rate of all 30 day complications. Stepwise backward multivariate logistic regression was used to control for confounders of the primary outcome. 301 of the 7,428 total patients (4.1%) underwent concomitant urogynecologic procedures. This population was older (49.7 vs 46.6 years, p Conclusion In this retrospective analysis of a large national cohort, the 30 day complication rate was greater than 50% higher when concomitant urogynecologic procedure was performed at the time of minimally invasive hysterectomy for a uterus >250gm.

Vaginal or laparoscopic hysterectomy: Do perioperative outcomes differ? A propensity score-matched analysis.

There are assertions that vaginal mode may be the preferred approach of minimally invasive hysterectomy, yet rates of laparoscopic hysterectomy (LH) continue to rise while vaginal hysterectomy (VH) rate remains relatively unchanged. The aim of this study is to compare the perioperative outcomes of LH vs VH. We identified women who underwent either LH or VH for benign indications between 2009 and 2015 at a large academic institution. A propensity score-matched analysis was used to adjust for differences between women undergoing VH vs LH. Outcome parameters were perioperative complications (both intraoperative and postoperative), operative time, blood loss, hospital length of stay, conversion and readmission. A total of 1921 patients underwent either LH or VH during the study period. In all, 155 patients from each group were successfully matched using propensity score match analysis. While most intra- and postoperative characteristics did not differ between groups, LH was associated with lower blood loss during surgery (102.8±166.5mL vs 185.0±179.0mL, P<0.001) and shorter hospital stay (0.9±1days vs 1.2±0.9days, P<0.0001). Concomitant adnexal surgery was performed more frequently during LH (47.7% vs 12.3%, P<0.0001), and concomitant prolapse surgery was performed more frequently at the time of VH (14.2% vs 68.4%, P<0.0001). Both VH and LH have overall favorable perioperative outcomes; however, LH is associated with lower blood loss and a shorter hospital stay. The results support the trend toward increasing rates of laparoscopic approach to hysterectomy when appropriate.

Utility of Intraoperative Cystoscopy in Detecting Ureteral Injury During Vaginal Hysterectomy

Ureteral injury is a serious complication of vaginal hysterectomy and other gynecologic surgery. Its incidence during vaginal surgery is estimated to be 0.9% to 1.7%. Although intraoperative cystoscopy can provide a timely diagnosis and expedite management, it is not routinely performed. Barriers to routine use include cost and training. As an alternative to cystoscopy, ureteral injury may be detected by symptoms, an increase in perioperative serum creatinine level, or both. The primary aim of this study was to determine the rate of ureteral injury and associated costs in patients undergoing selective cystoscopy during vaginal hysterectomy. Another aim was to determine whether changes in perioperative creatinine level could be used to reliably diagnose ureteral injury in the absence of intraoperative cystoscopy. A secondary analysis of a retrospective cohort study was performed. A total of 593 patients underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor repairs, from January 2, 2004, through December 30, 2005, at Mayo Clinic (Rochester, Minn). A logistic regression model was constructed to determine the propensity for a surgeon to perform intraoperative cystoscopy, in order to allow adjustment for the likelihood of detecting ureteral injury in a given surgical case. The rate of ureteral injury and associated cost was determined in patients undergoing surgery both with and without cystoscopy. In cases in which cystoscopy was not performed, standard practice of postoperative creatinine level determination allowed the authors to investigate the feasibility of using perioperative change in creatinine level to detect ureteral injury. Of the 593 eligible patients included in the analysis, 230 (38.8%) underwent cystoscopy during the hysterectomy. Ureteral injuries occurred in 6 patients (2.6%) in the cystoscopy group and 5 (1.4%) in the no-cystoscopy group; the odds ratio was 1.92, with a 95% confidence interval (CI) of 0.58 to 6.36, P = 0.35. After adjusting for the propensity to perform cystoscopy, the association was further attenuated (odds ratio, 1.31; 95% CI, 0.19–9.09). Five of the 6 were detected intraoperatively; of those, 4 were successfully managed intraoperatively. Adjusted mean-predicted costs for patients undergoing and not undergoing cystoscopy were $10,686 (95% CI, $7500–$13,872) and $10,217 (95% CI, $6894–$13,540), respectively; P = 0.28. The 5 patients with ureteral injury in the no-cystoscopy group had a median increase in perioperative creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease in creatinine level of 0.1 mg/dL (P < 0.001). Overall, the likelihood of ureteral injury with and without cystoscopy is similar, and predictive costs do not significantly differ. The use of postoperative creatinine level to detect ureteral injury is highly sensitive, but limited by a low positive predictive value and variable range. Based on these data, the authors recommend routine universal screening cystoscopy for patients undergoing vaginal hysterectomy.

Adnexectomy During Vaginal Hysterectomy for Benign Indications Using Bipolar Hemostasis of Lateral Pedicles and Transvaginal Adnexa Mobilization

Abstract Background: Using coagulation techniques to achieve hemostasis of lateral pedicles, or a fiberoptic light source to improve visibility in a narrow operating field, or transvaginal mobilization of adhered adnexa, may facilitate more salpingo-oophorectomies after vaginal hysterectomies for benign indications. Objectives: The aim of this research was to study the feasibility of adnexectomy during vaginal hysterectomy for benign indications, using bipolar coagulation to achieve hemostasis of the lateral pedicles and using transvaginal mobilization of adnexa. Materials and Methods: A prospective observational study was conducted from May 2010 through April 2014. Consecutive candidates for vaginal hysterectomy for benign nonprolapsed indications with adnexectomy (unilateral or bilateral) were included. The outcome of interest was success of adnexectomy during vaginal hysterectomy. Results: Adnexectomy during vaginal hysterectomy was completed successfully in 220 (97.34%) of 226 indicated cases. Unilate...

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies.

PurposeSome studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m2 the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m2).MethodsPubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis.ResultsTwo randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71–3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79–6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96–3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH.ConclusionsCompared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.

Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy.

The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy. We performed a secondary analysis of a retrospective cohort study of 593 patients who underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor reconstructive surgery, from January 2, 2004, through December 30, 2005. A logistic regression model determining the propensity to undergo intraoperative cystoscopy was constructed. Comparisons of ureteral injury and cost between patients with and without cystoscopy were adjusted for the cystoscopy propensity score. We further explored the feasibility of using perioperative change in creatinine level to detect ureteral injury. In total, 230 (38.8%) of 593 patients underwent cystoscopy. Six patients (2.6%) in the cystoscopy group and 5 (1.4%) in the no-cystoscopy group had ureteral injuries (odds ratio, 1.92; 95% confidence interval [CI], 0.58-6.36). This association was further attenuated after adjusting for the propensity to undergo cystoscopy (odds ratio, 1.31; 95% CI, 0.19-9.09). Four injuries detected cystoscopically were managed intraoperatively. Adjusted mean-predicted costs for patients undergoing cystoscopy were $10,686 (95% CI, $7500-$13,872) versus $10,217 (95% CI, $6894-$13,540). In the no-cystoscopy group, patients with ureteral injury had a median increase in creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease of 0.1 mg/dL (P < 0.001). The level of selection for cystoscopy did not significantly increase the mean predicted costs for patients. Reliance on postoperative creatinine level to detect ureteral injury, while highly sensitive, is limited by a low positive predictive value and variable range.

Transforming growth factor β1 and extracellular matrix protease expression in the uterosacral ligaments of patients with and without pelvic organ prolapse.

This study was undertaken to evaluate the expression of transforming growth factor β1 (TGF-β1) and matrix metalloproteinase 9 (MMP-9), key regulators of the extracellular matrix composition, in the uterosacral ligaments (USLs) of women with pelvic organ prolapse (POP) compared with controls. Under an institutional review board approval, USL samples were obtained from women undergoing vaginal hysterectomy for stage 2 or greater POP (cases, n = 21) and from women without POP undergoing vaginal hysterectomy for benign indications (controls, n = 19). Hematoxylin and eosin and trichrome staining were performed on the USL sections, and the distribution of smooth muscle and fibrous tissue were quantified. Immunohistochemical staining was performed using anti-TGF-β1 and anti-MMP-9 antibodies. The expressions of TGF-β1 and MMP-9 were evaluated by the pathologist, who was blinded to all clinical data. Transforming growth factor β1 expression positively correlated with MMP-9 expression (R = 0.4, P = 0.01). The expressions of TGF-β1 and MMP-9 were similar in subjects with POP versus controls. There was a significant increase in fibrous tissue (P = 0.008) and a corresponding decrease in smooth muscle (P = 0.03), associated with increasing age. The TGF-β1 expression, but not MMP-9 expression, also significantly increased with age (P = 0.02). Although our study uncovered age-related alterations in USL composition and TGF-β1 expression, there was no difference in the expression of TGF-β1 or MMP-9 in the subjects with POP versus controls.

Retrospective Analysis of Consecutive Cases of Vaginal Hysterectomy for Benign Indications Using Vessel Sealing Device

Retrospective Analysis of Consecutive Cases of Vaginal Hysterectomy for Benign Indications Using Vessel Sealing Device

Minimally invasive vaginal hysterectomy using bipolar vessel sealing: Preliminary experience with 500 cases

The objective of our study was to evaluate surgical outcome of minimally invasive vaginal hysterectomy (MIVH), using the bipolar vessel sealing system (BVSS; BiClamp®). The design was a retrospective analysis (Canadian Task-force Classification II-3). The setting was a secondary care hospital. Records of patients who underwent vaginal hysterectomy for benign indications in our centre between November 2005 and March 2011 were reviewed. The demographic patients’ data, indications for surgery, patient history with regard to previous surgery, duration of surgery, blood loss (postoperative haemoglobin drop ‘∆Hb’), perioperative complications, and length of inpatient stay were collected from the medical records. The intervention was vaginal hysterectomy using BVSS (BiClamp®). Results showed that the mean duration of surgery was 48.9 ± 15.3 min (95% CI, 49.2–52.5). The mean duration of hospital stay was 3.2 ± 1.2 days (95% CI, 2.8–3.2). The mean ∆Hb was 1.4 ± 1.8 g/dl. Overall, conversion to laparotomy was required in three cases (0.6%). Only one haemoperitoneum occurred (0.2%) and this is the only case who required blood transfusion. The main indication for VH was uterine prolapse in 52.0% (n = 260) of cases; uterine fibroids in 37.4% (n = 187); adenomyosis uteri in 4.2% (n = 21); cervical dysplasia in 22 patients (4.4%) and in 2% (n = 10) of patients, endometrial hyperplasia and other pathologies were the indications for VH. It was concluded that electrosurgical bipolar vessel sealing by (BiClamp®) can provide a safe and feasible alternative to sutures in vaginal hysterectomy, resulting in reduced operative time and blood loss, with acceptable surgical outcomes.

Outpatient Vaginal Hysterectomy

To present tactics for optimizing outpatient vaginal hysterectomy and describe perioperative outcomes in a large consecutive case series. This is a descriptive study and review of clinical outcomes in 1,071 patients selected to undergo vaginal hysterectomy for benign indications from 2000 to 2010. The setting is a single-surgeon private practice in a community hospital. Outcome measures include length of hospital stay, estimated blood loss, operative time, uterine weight, and perioperative complications, including hospital readmissions and emergency room visits. One thousand seventy-one of 1,162 cases (92%, 95% confidence interval [CI] 90.5-93.7) were total vaginal hysterectomies, of which 1,029 (96%, 95% CI 94.9-97.3) were discharged the same day after surgery. The median operative time was 34 minutes (range 17-210 minutes), and estimated blood loss was 45 mL (range 5-800 mL). The median patient age was 46 years (range 27-86 years), and median uterine weight was 160 g (range 25-1,380 g). One hundred ninety-three patients (18%, 95% CI 15.8-20.5) were nulliparous and 218 (20%, 95% CI 18-22.9) had prior pelvic surgery. Five patients (0.5%, 95% CI 0.2-1.1) required readmission or emergency room evaluation within the first 30 days. Vaginal hysterectomy can be successfully adopted as a same-day discharge procedure. In this population, regardless of previous pelvic surgery or nulliparity, good perioperative outcomes have been achieved.

Effects of vaginal hysterectomy on anorectal sensorimotor functions--a prospective study.

While bowel and bladder dysfunction are recognized consequences of a radical hysterectomy, the effects of a simple hysterectomy on anorectal sensorimotor functions, particularly rectal sensation, vary among studies and the effects on rectal compliance remain unknown. Our aims were to prospectively evaluate anorectal sensorimotor functions before and after a hysterectomy. Anal pressures, rectal compliance, capacity, sensation, and bowel symptoms were assessed before, at 2 months, and at 1 year after a simple vaginal hysterectomy for benign indications in 19 patients. Rectal staircase (0-44 mmHg, 4-mmHg steps), ramp (0-200 mL at 50, 200 and 600 mL min(-1)) and phasic distentions (8, 16, and 24 mmHg above operating pressure) were performed. Anal resting (63 ± 4 before, 56 ± 4 mmHg after) and squeeze pressures (124 ± 12 before, 124 ± 12 mmHg after), rectal compliance and capacity (285 ± 12 before, 290 ± 11 mL 1 year after), and perception of phasic distentions were not different before vs after a hysterectomy. Sensory thresholds for first sensation and the desire to defecate were also not different, but pressure and volume thresholds for urgency were somewhat greater (Hazard ratio = 0.7, 95% CI [0.5, 1.0]) 1 year after (vs before) a hysterectomy. Rectal pressures were higher (P < 0.0001) during fast compared with slow ramp distention; this rate effect was greater at 1 year after a hysterectomy, particularly at 100 mL (P = 0.04). A simple vaginal hysterectomy has relatively modest effects (i.e., somewhat reduced rectal urgency and increased stiffness during rapid distention) on rectal sensorimotor functions.

The effect of hysterectomy on urinary symptoms and residual bladder volume

This was a prospective, clinical study to evaluate the effect of abdominal and vaginal hysterectomy for benign indications on urinary symptoms and residual bladder volume. One hundred and seven women undergoing hysterectomy for benign conditions were included in the study that took place in a district general hospital between April 1998 and January 2000. Urinary symptoms such as stress incontinence of urine, urgency, frequency, nocturia, sensation of incomplete voiding and voiding difficulties were considered. A questionnaire was filled out and the residual bladder volume measured with a 'Bard' bladder scanner on three occasions--before the operation, postoperative days 3 or 4 and at the 6-week postoperative visit. Statistical analysis involved using a generalised estimating equation and significance assessed at the 5% level. Each woman acted as her own control. There was no evidence of changes in nocturia and voiding difficulties after surgery. All other symptoms and residual bladder volumes decreased significantly postoperatively. The type of hysterectomy did not have an effect.