Outcomes after Total versus Subtotal Abdominal Hysterectomy
ABSTRACT It is uncertain whether subtotal abdominal hysterectomy results in better bladder, bowel, or sexual function than total abdominal hysterectomy.
We conducted a randomized, double-blind trial comparing total and subtotal abdominal hysterectomy in 279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. The main outcomes were measures of bladder, bowel, and sexual function at 12 months. We also evaluated postoperative complications.
The rates of urinary frequency (urination more than seven times during the day) were 33 percent in the subtotal-hysterectomy group and 31 percent in the total-hysterectomy group before surgery, and they fell to 24 percent and 20 percent, respectively, at 12 months (P=0.03 for the change over time within each group; P=0.84 for the interaction between the treatment assignment and time). The reduction in nocturia and stress incontinence and the improvement in bladder capacity were similar in the two groups. The frequency of bowel symptoms (as indicated by reported constipation and use of laxatives) and measures of sexual function (including the frequency of intercourse and orgasm and the rating of the sexual relationship with a partner) did not change significantly in either group after surgery. The women in the subtotal-hysterectomy group had a shorter hospital stay (5.2 days, vs. 6.0 in the total-hysterectomy group; P=0.04) and a lower rate of fever (6 percent vs. 19 percent, P<0.001). After subtotal abdominal hysterectomy, 7 percent of women had cyclical bleeding and 2 percent had cervical prolapse.
Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.
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- "Our results showed no deterioration in libido, orgasmic ability or sexual satisfaction after surgery and thus support the latter studies. In fact, the significant increase in the proportion of sexually active women and reduction in deep dyspareunia after surgery indicate that hysterectomy could be beneficial to the group of patients whose sexual activity might have been hampered by preoperative disease (Dwyer et al., 1993; Sculpher et al., 1996; Thakar et al., 2002). Unique to this study is the comparison between the effects of the different surgical routes of hysterectomy on urinary and sexual function. "
ABSTRACT: A prospective observational study was designed to evaluate the effect of the different techniques of hysterectomy on urinary and sexual function. One hundred and eighty-seven women aged 29-73 years and admitted for hysterectomy for various indications were recruited to the study. Women presenting primarily with major uterine prolapse and those requiring radical hysterectomy were excluded. Patients underwent one of four different techniques of hysterectomy: total abdominal, vaginal, laparoscopic or subtotal. All patients completed a standardised questionnaire addressing urinary and sexual symptoms and underwent urodynamic testing using the Lectromed 6000 System (Lectromed, Letchworth, Herts, UK) before and 6 months after surgery. Out of 187 women, 184 (98.4%) had completed data. Seventy-three patients (39%) had a total abdominal hysterectomy, 62 (34%) had vaginal, 38 (21%) had laparoscopic and 11 (6%) had subtotal hysterectomy. At 6 months after surgery, urinary symptoms occurred less frequently (P<0.01) and urodynamic studies remained unchanged. Moreover, patients reported significantly lower rates of stress incontinence (P=0.005), urgency (P=0.03) and deep dyspareunia (P<0.001) than before the operation, regardless of the hysterectomy technique used. The route of hysterectomy did not influence the outcome of surgery. We conclude that simple hysterectomy, whether performed abdominally, vaginally or laparoscopically, does not adversely affect urinary or sexual function at 6 months after surgery.Journal of Obstetrics and Gynaecology 06/2004; 24(4):420-5. DOI:10.1080/01443610410001685574 · 0.60 Impact Factor
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ABSTRACT: Combined urinary and faecal (liquid or solid) incontinence (double incontinence) is the most severe and debilitating manifestation of pelvic floor dysfunction. The community prevalence is 9-19% (urinary) and 5-10% (faecal), increasing with age. Pathophysiological factors include childbirth-associated external anal sphincter injury and pudendal nerve damage, pelvic floor descent, menopause, collagen disorders and multiple sclerosis-like conditions. The presence of crossed reflexes between the bladder, urethra, anorectum and pelvic floor in animal studies may explain the comorbidity of urinary and faecal urgency. Surgical treatment is based on aetiology and combined optimum techniques such as colposuspension or suburethral sling with overlapping sphincteroplasty. Other methods for improving sphincteric control include sacral nerve neuromodulation, bulking agents and artificial sphincters.International Urogynecology Journal 08/2005; 16(4):321-8. DOI:10.1007/s00192-004-1283-0 · 2.16 Impact Factor