Outcomes after Total versus Subtotal Abdominal Hysterectomy

Department of Gynecology, St. George's Hospital, London, United Kingdom.
New England Journal of Medicine (Impact Factor: 54.42). 10/2002; 347(17):1318-25. DOI: 10.1056/NEJMoa013336
Source: PubMed

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. "
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