Prolapse of the vagina after hysterectomy

Twenty-two patients were operated upon for posthysterectomy vaginal prolapse. The original operation had been abdominal hysterectomy in 11 patients and vaginal hysterectomy in an additional 11 patients. All of the corrective operations were performed abdominally. Vaginal sacropexy was performed upon eight patients with our own modified method using a fascial strip taken from the rectum sheath. Dexon sutures were used in the attachment of the strip to the apex of the vagina and to the periosteum of the sacrum. The fascial strip was peritonealized. A high resection of the enterocele sac was performed. Excellent permanent vaginal support was achieved in all of these patients. Other methods of operation used included direct fixation of the vaginal apex to the presacral fascia, fixation of the vagina with round ligaments and the method according to Williams and Richardson. More than one-half of the patients had recurrences.     

Prolapse after a hysterectomy. A study of 70 cases

The authors report on 70 cases of prolapse following hysterectomy (52 cases after subtotal hysterectomy, 13 after total abdominal hysterectomy, and 5 after vaginal hysterectomy). These cases of prolapse following hysterectomy represent 11,7 p. cent of all surgery performed to correct prolapse over the same period (70/599). It is desirable to repair the vagina as anatomically as possible, preserve normal function (70% of patients desire to remain sexually active), and correct if necessary urinary incontinence also present in 47 p. cent of patients in our series. Once the decision to operate has been made, we believe the best procedure is a pubosacral suspension (double hemi-hammock) using a Mersilence strap, which treats the associated stress incontinence and preserves sexual function.     

Infection after hysterectomy

Antibiotic prophylaxis and advances in technology have reduced operative site infections after hysterectomy to a minimum. Pelvic infections are the most common infection type and respond promptly to a variety of parenteral single-agent and combination antibiotic regimens. Oral antibiotic regimens following parenteral therapy are unnecessary. Abdominal incision infections are less common than pelvic infections, less common than seromas or hematomas, and usually do not require antimicrobial therapy. Abscesses or infected hematomas require parenteral antimicrobial therapy, and drainage of those located above the cuff will predictably shorten therapy time. With early discharge from the hospital, many infections will not become evident until after the patient is home. For that reason, it is important that the patient's discharge instructions outline symptoms and signs associated with these infections so she can present for care at the earliest possible time.     

Sexuality after hysterectomy

OBJECTIVE: To review the literature regarding sexuality after hysterectomy and identify areas for future research. DATA SOURCES: Articles published between 1970 and 2000 on sexuality and hysterectomy were located using MEDLINE, CINAHL, Psychlit, and Sociofile databases. STUDY SELECTION: English language research dealing with the topic was reviewed. DATA EXTRACTION: Study findings were categorized and include studies of the effect of hysterectomy on sexuality, women's perspectives on hysterectomy, and information sharing with women prior to surgery. DATA SYNTHESIS: A number of studies have explored sexuality after hysterectomy. Many of these studies have methodologic flaws, including vague measures of sexual satisfaction and potential for recall bias. A major source of bias is that the first measure of sexual satisfaction/functioning was performed in the immediate preoperative period when symptoms are more likely to affect sexual functioning. CONCLUSIONS: There are a number of gaps in the knowledge base pertaining to this topic. Future research in this area is needed to provide direction for nurses in the clinical area. Topics for future research include what women and their partners want to know about sexuality following hysterectomy and the most efficient methods to provide them with this information. In addition, sexuality in premorbid women needs to be more fully described.     

Pregnancy after vaginal hysterectomy

Ectopic pregnancy after a total hysterectomy represents an unusual event. A survey of the literature reveals 29 reported cases. This report presents an additional case of early extrauterine gestation after total vaginal hysterectomy. Sonographic correlation is demonstrated.     

Sexual life after hysterectomy

OBJECTIVES: The evaluation of sexual life after hysterectomy is still controversial. DESIGN: The aim of the study was to analyse the impact of hysterectomy on frequency and quality of the woman's sexual life. MATERIAL AND METHODS: The total of 539 women operated in II Department of Obstetrics and Gynecology in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after abdominal hysterectomy. RESULTS: Sexual desire after operation decreased. The rate of dyspareunia dropped. Frequency of sexual intercourse and orgasm decreased non-significantly. The percentage of women non reporting vaginal dryness decreased significantly from 18.5% to 37.3% after hysterectomy. CONCLUSION: Sexual activity overall improved after hysterectomy.     

Cirsoid aneurysm after hysterectomy

Cirsoid aneurysm, an uncommon abnormal either congenital or acquired arteriovenous communication, is described. As massive life-threatening bleeding can be a consequence, diagnosis is very important. Earlier, angiography was the only imaging method available for visualizing vascular lesions and recent developments in imaging techniques have made diagnostic imaging of cirsoid aneurysms possible using ultrasonography, color flow mapping, magnetic resonance imaging and magnetic resonance angiography. In this report, a patient with intrapelvic cirsoid aneurysm posthysterectomy who died 8 h after she had been kicked in the abdomen is described and the results obtained by various imaging techniques are discussed.     

The residual ovary after hysterectomy

Of 118 cases of patient who had undergone abdominal hysterectomy with the preservation of one or both the ovaries, only 73 patients (62%) attended for review. Eleven had had cysts of the residual ovary. The occurrence of an asymptomatic pathology in three cases suggest that patients, for whom preservation of an ovary was considered preferable, should undergo a periodic clinical and ultrasonographic review.