Vaginal Hysterectomy For Uterine Prolapse Research Articles

Surgery for women with apical vaginal prolapse.

Surgery for women with apical vaginal prolapse.

Complications after benign hysterectomy, according to procedure: a population‐based prospective cohort study from the Danish hysterectomy database, 2004–2015

To compare the risk of complications associated with benign hysterectomy according to surgical procedure. Register-based prospective cohort study. Danish Hysterectomy Database, 2004-2015. All Danish women with benign elective hysterectomy (n=51141). Multivariate log-binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight and adhesions. Multiple imputation and 'intention to treat' analyses were performed. Major (gradesIII-V) and minor (gradesI-II) Clavien-Dindo modified complications within 30days. Overall, major complications occurred in 3577 (7.0%) hysterectomies and minor complications occurred in 4788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were: 10.3 and 9.6% for abdominal hysterectomy (AH); 4.1 and 12.1% for laparoscopic hysterectomy (LH); and 4.9 and 8.0% for vaginal hysterectomy (VH) for non-prolapse, and 2.3 and 6.4% for prolapse. In multivariate analyses, compared with VH for non-prolapse, the risk of major complications was higher for AH (RR1.82, 95%CI 1.63-2.03) but lower for both LH (RR0.78, 95%CI 0.68-0.90) and VH for prolapse (RR0.55; 95%CI 0.41-0.75). For LH, the risk of major complications reduced from a RR of 0.96 (95%CI 0.75-1.22) in the time period 2004-2009 to an RR of 0.72 (95%CI 0.60-0.87) between 2010 and 2015. Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, and AH is associated with more major complications, compared with VH performed in the absence of uterine prolapse. Laparoscopic hysterectomy has fewer major complications compared with vaginal hysterectomy, in the absence of uterine prolapse.

Surgery for women with apical vaginal prolapse.

Surgery for women with apical vaginal prolapse.

子宮脱の術後に判明した子宮体癌に対し、腹腔鏡下手術を追加した1例

Objective: To describe an occult endometrial adenocarcinoma discovered unexpectedly after a vaginal hysterectomy performed for uterine prolapse.Design: Case reportPatient: a 52-year-old perimenopausal gravida 3, para 3 who presented with symptomatic pelvic organ prolapse.Intervention: a vaginal hysterectomy performed for uterine prolapse followed by a laparoscopic salpingo-oophorectomy.Results: The patient was preoperatively diagnosed with uterine prolapse, small myomas, and an endometrial polyp. Preoperative multiple endometrial samplings appeared normal except for the presence of an endometrial polyp. An early stage endometrial adenocarcinoma was discovered unexpectedly after a vaginal hysterectomy for uterine prolapse. Therefore, she underwent a laparoscopic bilateral salpingo-oophorectomy six weeks after the initial procedure. The pathologic findings showed no evidence of residual cancer. Two years postoperatively, there was no evidence of recurrence.Conclusions: In cases such as this, the patient must be informed of the possibility of recurrent disease when a laparoscopic bilateral salpingo-oophorectomy without the lymphadenectomy is chosen. In addition, the treatment of early stage endometrial adenocarcinoma by a vaginal hysterectomy followed by laparoscopic surgery may be one of the options for carefully selected patients who wish to undergo minimally invasive surgery.

Factors affecting the feasibility of bilateral salpingo-oophorectomy during vaginal hysterectomy for uterine prolapse

About 15% of all hysterectomies are performed for pelvic organ prolapse, generally through the transvaginal approach. However, concomitant bilateral salpingo-oophorectomy (BSO) is not always feasible through this approach, because the adnexae are sometimes inaccessible. To identify factors affecting the feasibility of performing BSO during transvaginal hysterectomy for uterine prolapse. We reviewed charts of all women undergoing vaginal hysterectomy for uterine prolapse in our institution between December 2005 and November 2009, at which time BSO was uniformly attempted in all patients. One hundred and seventy-two women who underwent vaginal hysterectomy were identified, of whom 134 (78%) underwent concomitant BSO. Women in whom BSO was feasible were younger (60.6±10.1 vs 65.6±8.6 years, P<0.02) and had a higher prevalence of advanced prolapse, including stage IV cystocele (68% vs 38%, P=0.01), stage III-IV rectocele (40% vs 11%, P=0.003) and stage IV uterine prolapse (64% vs 25%, P=0.0005). The feasibility of BSO was primarily dependent on the stage of pelvic organ prolapse and patients' age. Relaxation of the adnexae because of weakness of the infundibulo-pelvic ligaments may accompany severe pelvic organ prolapse and may potentially explain the feasibility of BSO in these women.

Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report

IntroductionLichen planus is an immune mediated inflammatory lesion involving skin and mucosal sites including oral mucosa, vulva and rarely vagina. Lichen planus occurring at mucosal sites has been shown to be associated with squamous cell carcinoma in a proportion of cases. To the best of our knowledge, no case of lichen planus of uterine cervix has been reported in the available literature.Case PresentationA 45-year-old female underwent vaginal hysterectomy for uterine prolapse. The resected specimen showed a bluish-colored area in the non-dependent part of the ectocervix. Microscopic sections from this area showed dense lymphocytic infiltrate at the junction of mucosa and submucosa causing disruption of the basal cell layer. On immunohistochemical examination there was predominance of CD8+ T lymphocytes at the junction with scattered CD4+ T lymphocytes, characteristic of lichen planus. Based on the history and negative serum antibody titers, other differential diagnoses including lupus erythematosus and drug reaction were excluded. The patient did not have any cutaneous or oral lesions of lichen planus.ConclusionLichen planus of uterine cervix is a hitherto unreported entity, and is worth studying considering the premalignant potential of lichen planus at other mucosal sites.

Vaginal evisceration after hysterectomy: a rare condition a gynecologist should be familiar with

To report a case of vaginal vault rupture with intestinal herniation per vagina after hysterectomy and highlight the risk factors, clinical presentation and treatment options of this rare gynecologic emergency. A 70-year-old woman presented to the emergency department with vaginal evisceration, emerged 4 years after vaginal hysterectomy for uterine prolapse. Approximately 30 cm of the terminal ileum was irreducibly protruding through the vagina. The patient was transferred to the operating theatre. The prolapsed bowel was reduced via the combined vaginal-abdominal route and the vaginal cuff was closed with non-absorbable interrupted sutures. Awareness as well as high suspicion index among gynecologists and all involved care givers, is important for early diagnosis, given that vaginal evisceration is a potentially life-threatening condition necessitating prompt surgical intervention.

Gossypiboma—Retained Surgical Sponge

Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.

Comparison of ureteral and cervical descents during vaginal hysterectomy for uterine prolapse

Objective: The study measured ureteral and cervical locations during vaginal hysterectomy for prolapse and the extent of parametrial ligament shortening possible. Study Design: Cervical and ureteral position were measured in 26 women undergoing uterine prolapse correction. Parametrial clamp tip location was also measured. Results: The cervix lay between 0 and –14.5 cm (below) the hymen (mean ± SD –5.35 ± 3.96 cm) and the ureters lay +5.0 to –4.0 cm (mean ± SD +1.89 ± 1.99 cm). Correlation of ureteral with cervical position was 0.69 ( P < .01) and correlation with ipsilateral uterosacral ligament clamp positions was 0.80 ( P < .01). Regression line slope relating cervical descent and cervix to ureter distance was 0.65, indicating that for every 3 cm of cervical descent there was 2 cm widening of the gap between the cervix and ureters and 1 cm descent of the ureter. Conclusion: For every 3 cm of cervical descent the ureters descend 1 cm, thereby widening the ureterocervical gap and permitting ligament shortening during vaginal hysterectomy. (Am J Obstet Gynecol 1998;179:1405-10.)

Transvaginal colposuspension for the treatment of genuine stress incontinence combined with vaginal hysterectomy: a preliminary report.

The authors used a new, simple, modified transvaginal needle colposuspension technique in combination with vaginal hysterectomy for uterine prolapse and cystocele repair. The technique was used in 20 women with genuine stress incontinence which was urodynamically proven. One year after operation, 90% of patients were clinically normal and 85% were urodynamically cured. The advantages of this new technique are that the cost of the needle is low, it can be applied in all cases where a vaginal approach is necessary, and the method of needle insertion avoids perforation of the bladder.

The role of vaginal hysterectomy in the aged woman.

The results of vaginal hysterectomy in 85 women over the age of 65 were reviewed. All the patients' complaints were attributable to uterine prolapse but the frequency of occurrence was not proportional to the given patients' degree of disability. Spinal anesthesia was used the most frequently, as it is usually not contraindicated in the elderly. Certain postoperative complications were encountered, but these did not cause prolongation of the hospital stay. No postoperative deaths occurred. Most of the patients showed complete improvement in terms of personal activity. It is concluded that vaginal hysterectomy for uterine prolapse is a safe and beneficial operation in the elderly and is preferable to the more limited procedures employed years earlier.

Pseudomembranous colitis. A fatal case following prophylactic cephaloridine therapy

DIARRHEA and pseudomembranous colitis are recognized complications of antibiotic use. Clindamycin hydrochloride 1 has been implicated in most of the cases, but chloramphenicol sodium succinate, 2 ampicillin sodium, 3 lincomycin hydrochloride monohydrate, 4,5 and tetracycline hydrochloride 6,7 may also cause the disease. Combinations of antibiotics that have included a cephalosporin drug have been implicated in several reports of this disorder. 8 However, we are aware of only two case reports of colitis following the use of cephalosporin alone. 9,10 This report describes a fatal case of cephaloridine-associated colitis. Report of a Case A 67-year-old woman underwent vaginal hysterectomy for uterine prolapse on Oct 5, 1978. On the same day, preoperatively, she received 1.0 g of cephaloridine intramuscularly prophylactically and then 0.5 g intravenously every six hours postoperatively. There was no history of gastrointestinal disorders, and she had been receiving no medications prior to hospital admission. On the first postoperative day,

Pseudomembranous Colitis

DIARRHEA and pseudomembranous colitis are recognized complications of antibiotic use. Clindamycin hydrochloride 1 has been implicated in most of the cases, but chloramphenicol sodium succinate, 2 ampicillin sodium, 3 lincomycin hydrochloride monohydrate, 4,5 and tetracycline hydrochloride 6,7 may also cause the disease. Combinations of antibiotics that have included a cephalosporin drug have been implicated in several reports of this disorder. 8 However, we are aware of only two case reports of colitis following the use of cephalosporin alone. 9,10 This report describes a fatal case of cephaloridine-associated colitis. Report of a Case A 67-year-old woman underwent vaginal hysterectomy for uterine prolapse on Oct 5, 1978. On the same day, preoperatively, she received 1.0 g of cephaloridine intramuscularly prophylactically and then 0.5 g intravenously every six hours postoperatively. There was no history of gastrointestinal disorders, and she had been receiving no medications prior to hospital admission. On the first postoperative day,