Risk of urge and stress urinary incontinence at long-term follow-up after vaginal hysterectomy

OBJECTIVE: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN: One hundred seventeen patients who had a vaginal hysterectomy for menorrhagia from January 1991 to December 2001 answered a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the 2 groups. Mean follow-up was 4.6+/-2.2 years (range, 1.5-11 years) after vaginal hysterectomy and 4+/-1.8 years (range, 1.5-7 years) after conservative treatment. The prevalence of urinary symptoms, which included urge and stress incontinence, was statistically similar in the 2 groups. CONCLUSION: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.     

Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up?

OBJECTIVE: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN: One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6+/-2.2 years (range 1.5-11) after vaginal hysterectomy and 4+/-1.8 years (range 1.5-7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups. CONCLUSION: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.     

Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse

OBJECTIVE: We sought to demonstrate that a positive pessary test could predict postsurgical stress urinary incontinence in women with severe pelvic organ prolapse and that performing tension-free vaginal taping (TVT) could effectively prevent its occurrence. METHODS: Among the 79 patients evaluated for severe pelvic organ prolapse without symptoms of stress urinary incontinence, all underwent meticulous urogynecologic evaluations and pessary testing. In group 1, 32 patients had positive pessary tests and underwent vaginal hysterectomy, anterior and posterior colporrhaphy, and TVT. In group 2, 47 patients (17 of whom had positive pessary tests and 30 of whom had negative pessary tests) underwent vaginal hysterectomy and anterior and posterior colporrhaphy alone. A comparison in terms of surgical outcome and clinical manifestations was made between these 2 groups of patients. RESULTS: After surgery, a small proportion of patients had de novo idiopathic detrusor overactivity (7.6%, n = 6), urinary tract infections (7.6%, n = 6), mild recurrent prolapse (5.1%, n = 4), and urinary retention (3.8%, n = 3). Eleven (64.7%) of 17 patients with positive pessary tests who did not undergo TVT had urine leakage after their hysterectomies in contrast with the 30 patients who had negative pessary test, none of whom developed symptomatic stress urinary incontinence after vaginal hysterectomy. Among the 32 patients with positive pessary tests who had TVT with their hysterectomies, 3 developed urine leakage later; the cure rate was 90.6%. CONCLUSION: Continent patients suffering from severe pelvic organ prolapse but with a positive pessary test are considered to be at high risk of developing postoperative symptomatic stress urinary incontinence. Among the patients in our medium-range study, TVT effectively prevented postsurgical urinary incontinence. LEVEL OF EVIDENCE: II-1     

Uterosacral ligament fixation for vaginal vault suspension in uterine and vaginal vault prolapse

OBJECTIVE: The purpose of this study was to determine the simplicity, safety, anatomic, and functional success of using the uterosacral ligaments for correction of significant complex uterine and vaginal vault prolapse by the vaginal route. STUDY DESIGN: Fifty women with uterine or vaginal vault prolapse with descent of the cervix or the vaginal vault to the introitus or greater were treated between 1993 and 1996 by the same surgeon with bilateral uterosacral ligament fixation to the vaginal cuff by the vaginal route. Included were patients with significant enterocele, cystourethrocele, rectocele, and stress urinary incontinence who had concomitant repair of coexisting pelvic support defects. An etiology of vaginal vault prolapse is discussed. RESULTS: Uterosacral ligaments were identified and used for successful vaginal vault suspension by the vaginal route in all 50 consecutive patients without subsequent failure or significant complications with a maximum follow-up of 4 years. One patient had recurrent stress urinary incontinence and two had asymptomatic cystoceles. Three patients had erosion of monofilament sutures at the vaginal apex. CONCLUSIONS: In these 50 patients with significant complex uterine or vaginal vault prolapse, uterosacral ligaments could always be identified and safely used for vaginal vault suspension by the vaginal route with no persistence or recurrence of vaginal vault prolapse 6 to 48 months after surgery. Excessive tension by the surgeon on tagged uterosacral ligaments at the time of hysterectomy may be an etiologic factor in vaginal vault prolapse.(Am J Obstet Gynecol 1997;177:44)     

Clinical outcome of transobturator tape concomitant with vaginal hysterectomy plus anterior posterior colporrhaphy

Objective  Transobturator tape (TOT) is a newly described procedure for the treatment of female stress urinary incontinence. The success of TOT operation along with prolapsed surgery has not been well described. The aim of this study is to determine the complication and success rates of TOT concomitant with pelvic prolapse surgery. Study design  Totally, 72 women who had TOT operation along with vaginal hysterectomy, anterior posterior colporrhaphy were re-evaluated with UDI6 and IIQ7 forms 1 year of surgery. Preoperatively, all patients had clinically pure stress incontinence. Results  At 1 year, 80.6% of patients were cured with only 16.7% presenting de novo urge incontinence, while 2.8% of women retaining stress urinary incontinence. The patients with lower gravida and number of vaginal delivery had significantly higher operation success rates. The IIQ7 score significantly increased by increase in urinary catheter stay day. The women with the history of cesarean delivery and lower hospital stay had significantly higher satisfaction scores. Of the factors only, the number of gravida could be used to predict treatment failure in the entire group. Conclusion  Transobturator tape procedure could be accompanied safely with prolapse surgery.     

The effect of different types of hysterectomy on urinary and sexual functions: a prospective study.

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.     

Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence

OBJECTIVE: The purpose of this study was to measure the risk of reoperation for surgically treated pelvic organ prolapse and urinary incontinence in a community-based population. STUDY DESIGN: A 5-year prospective, observational study was conducted of women who had undergone pelvic organ prolapse and urinary incontinence surgery in 1995. The cohort of 376 women was identified by International Classification of Diseases, 9th revision, and current procedural terminology codes in 149,554 reproductive-aged women within the Kaiser Permanente Northwest membership. RESULTS: Thirty-six women underwent 40 cases of reoperation. By survival analysis, 13% of women underwent reoperation by 71 months. Having undergone previous pelvic organ prolapse and urinary incontinence surgery increased the risk of reoperation to 17% compared with 12% for women who underwent a first procedure (log rank, P=.04). No association was observed with age, body mass index, parity, previous hysterectomy not for prolapse, vaginal versus abdominal approach, severity of prolapse, ethnicity, chronic lung disease, smoking, previous corticosteroid use, and estrogen status. CONCLUSIONS: Future reoperation is a significant risk of morbidity for women who undergo pelvic organ prolapse and urinary incontinence surgery.     

Long term complications of vaginal hysterectomy: a case control study

OBJECTIVE: Our purpose was to evaluate the long term sequelae after vaginal hysterectomy. STUDY DESIGN: A retrospective case control study to evaluate the long term complications after vaginal hysterectomy compared with control patients who had during the same period undergone cholecystectomy for benign pathology. Excluded were hysterectomies during which adnexectomy or treatment of prolapse, stress incontinence or genital cancer was also effected. We selected 221 patients who had undergone simple vaginal hysterectomy and 232 where cholecystectomy had been performed. The questionnaire listed 149 questions that dealt with matching characteristics and queries relating to symptoms. RESULTS: 117 questionnaires suitable for analysis were received from the patients in the hysterectomy group and 95 from the cholecystectomy group. After the matching process 61 patients who had a simple vaginal hysterectomy and 58 who had undergone cholecystectomy were selected. After simple vaginal hysterectomy there was a significant worsening of all urinary problems, of digestive problems and sexual intercourse. After cholecystectomy there is also an increase in the severity of most symptoms surveyed. CONCLUSION: Many long-term complications following hysterectomy cannot be attributed to the intervention. Vaginal hysterectomy should not be considered as being responsible for major complications appearing during the first 4 years of follow-up.     

Concomitant surgery with tension-free vaginal tape

BACKGROUND: To evaluate the efficacy and feasibility of tension-free vaginal tape (TVT) surgery combined with gynecologic surgery using general anesthesia. METHODS: One hundred and six women with genuine stress incontinence (GSI) diagnosed with a traditional urodynamic examination were prospectively enrolled into this study. All of the 106 women underwent TVT surgery for the treatment of GSI, along with a concomitant hysterectomy procedure, under general anesthesia. We estimated the severity of incontinence symptoms on a visual analog scale (VAS), and used a questionnaire for subjective assessment before and after TVT surgery. The objective assessment of urinary incontinence was carried out with a 1-h pad test and traditional urodynamic examination. Of the 106 patients, 50 had uterine prolapse and underwent transvaginal hysterectomy and anteroposterior colporrhaphy (APC), and another 50 had uterine myoma and underwent laparoscopic-assisted vaginal hysterectomy (LAVH). RESULTS: The follow-up mean interval was 18 months (range 12-36 months). The 50 women undergoing LAVH and TVT surgery had a mean hospitalization of 3.5 days. The subjective success rate was 90.5% and the objective success rate was 86.8%. The other group of 50 women undergoing vaginal total hysterectomy (VTH), APC and TVT surgery had a mean hospitalization of 4.8 days. The subjective success rate was 88.6% and the objective success rate was 84.9%. There were six patients lost to follow-up for several reasons. The rates of complications of bladder perforation, postoperative voiding difficulty and postoperative urinary urgency were 2%, 11% and 10%, respectively; neither pelvic hematoma requiring blood transfusion nor conversion to laparotomy occurred. CONCLUSION: The results of this study prove that the TVT procedure, performed under general anesthesia without the need for the intraoperative cough provocation test to treat GSI, and carried out concomitantly with other gynecologic surgeries, is safe and effective.     

Combined tension-free vaginal tape and prolapse repair under local anaesthesia in patients with symptoms of both urinary incontinence and prolapse

OBJECTIVE: To study the combination of tension-free vaginal tape (TVT) and prolapse repair under local anaesthesia in patients suffering from stress incontinence and prolapse. STUDY DESIGN: The study was designed as a prospective, open, nonrandomized study. A standardized protocol was used for pre- and postoperative evaluation. Check-ups were performed after 2, 6, 12 and 24 months. The protocol included medical history, stress test (supine and standing position with a comfortably filled bladder), life quality assessment including a visual analogue scale, 24- to 48-hour pad test, and 48-hour micturition diary. PATIENTS: In total 32 patients participated. All suffered from urinary stress incontinence (grade 1-3) and prolapse (grade 1-3). 2 patients had previously undergone surgery 2 and 3 times, respectively, for urinary incontinence with methods other than TVT (traditional anti-incontinence surgery). 3 patients had a history of total hysterectomy. 1 patient had a large rectocele with urinary and faecal incontinence. Mean age was 54 (range 31-74) years, mean parity 2 (range 0-5), and mean duration of incontinence 13 (range 2-29) years. SURGICAL TECHNIQUE: TVT was carried out according to the standardized technique as originally described. The prolapse repair included anterior and/or posterior colporrhaphy. All operations could be performed under local anaesthesia. RESULTS: 30 of 32 patients (93%) were cured. One patient (3%) was considerably improved, and 1 patient (3%) was considered a failure. Mean urinary leakage in 24 h was 96 (range 12-355) g preoperatively, and postoperatively 2.7 (range 0-28) g. Mean intraoperative bleeding was 75 (range 25-300) ml. Mean residual urine preoperatively was 15 (range 0-85) ml, and postoperatively 7 (range 0-40) ml. The mean stay in hospital after surgery was 2 (range 1-5) days. No postoperative urinary retention, no defective healing, and no tape rejection occurred. There was one uneventful bladder perforation in a patient who had previously undergone traditional incontinence surgery. This patient left the hospital the day after surgery without postoperative catheterization. CONCLUSION: The study clearly demonstrates that TVT can be combined with prolapse surgery to effectively treat symptoms of prolapse and urinary stress incontinence.     

盆腔器官脱垂及压力性尿失禁的相关因素分析

目的:探讨盆腔器官脱垂及压力性尿失禁的相关危险因素。方法:选择2007年1月至2016年1月在郑州大学第三附属医院盆底重建科行盆底重建术患者625例,将其中盆腔器官脱垂患者454例为A组,压力性尿失禁患者171例为B组,另选择体检的健康女性449例为对照组。分别统计分析其孕产次,是否绝经,有无子宫切除、慢性高血压、糖尿病、会阴裂伤、子宫肌瘤及阴道分泌物分析结果等资料,并进行单因素和多因素Logistic回归分析。结果:单因素分析示:A组子宫切除、已绝经、会阴裂伤患者所占比例均明显高于对照组(P0.05);B组慢性高血压、会阴裂伤的患者所占比例均明显高于对照组(P0.05);A组、B组多孕次(≥3次)、多产次(≥3次)患者所占比例高于对照组(P0.05),存在乳杆菌患者所占比例低于对照组(P0.05)。多因素Logistic回归分析示:子宫切除、已绝经、会阴裂伤、孕次≥3次、产次≥3次是盆腔器官脱垂的独立危险因素;会阴裂伤、孕次≥3次、产次≥3次是压力性尿失禁的独立危险因素。存在乳杆菌是盆底器官脱垂和压力性尿失禁的保护因素。结论:子宫切除、多孕、多产、会阴裂伤可能参与了盆腔器官脱垂及压力性尿失禁的发生发展,阴道乳杆菌的存在可能减少盆腔器官脱垂及压力性尿失禁的发生。     

The importance of the endopelvic fascia repair during vaginal hysterectomy.

During 1985 to 1989, 177 vaginal hysterectomies were performed in the Department of Gynecology, Kaplan Hospital, Rehovot, Israel, using the Porges technique with some modifications. Ninety patients had some degree of loss of the pelvic support--anterior or posterior wall relaxation, enterocele or uterine prolapse in various degrees. The patients were allocated to two groups, in which two different techniques were compared: group 1, with repair of the pubocervical and pararectal fascia and group 2 without the repair. The repair of the pubocervical and pararectal fascia after vaginal hysterectomy prevented vaginal vault prolapse (zero versus 15 percent, p < 0.01) and reduced the incidence of recurrent rectocele (23 versus 55 percent, p < 0.05) and recurrent cystocele (14 versus 45 percent, p < 0.005). Recurrent genuine stress incontinence was found in 9 percent of patients in group 1 and 18 percent of patients in group 2 (not statistically significant; p = 0.163). Optimal management of relaxation of the vaginal wall during vaginal hysterectomy requires clinical suspicion and precise preoperative diagnosis and therapeutic plan. In the present study, the need for careful repair of the pubocervical and pararectal fascia during vaginal hysterectomy to prevent vaginal vault prolapse is emphasized. This procedure does not prolong the operation significantly (92 +/- 15 versus 84 +/- 17 minutes) and has no deleterious postoperative complications.     

Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept

OBJECTIVE: The purpose of this study was to evaluate the efficacy of the performance of sacrospinous cervicocolpopexy with uterine conservation in the treatment of uterovaginal prolapse in women over the age of 60 years. STUDY DESIGN: This was a nonrandomized prospective controlled study. Between February 1996 and January 2001, 109 women above the age of 60 years with a complaint of symptomatic uterovaginal prolapse were treated with either sacrospinous cervicocolpopexy with uterine conservation or vaginal hysterectomy concomitant with sacrospinous colpopexy. Patients were reviewed at 6 weeks and 6 and 12 months after operation and then yearly thereafter. Preoperative patient characteristics, operative, and postoperative events and follow-up results were recorded. RESULTS: During the study period, 61 patients (56%) underwent sacrospinous cervicocolpopexy with uterine conservation (group A), whereas 48 patients (44%) had vaginal hysterectomy performed concomitantly with sacrospinous colpopexy (group B). The mean age for the two groups was comparable (70.1 +/- 6 years vs 69.4 +/- 4.6 years, respectively; P =.8). Group A had significantly less blood loss (P <.01), shorter operating time (P <.01), and fewer complications after surgery (P =.01) compared with group B. After a mean follow-up period of 33 and 34 months, respectively, the two groups had comparable success rates with regard to uterine and upper vaginal support (93.5% and 95.9%, respectively; P =.6). Recurrent cystocoele developed in 11.4% and 10.4% of groups A and B, respectively (P =.9). Within the follow-up period, 3 patients (5%) in group A and 2 patients (4.2%) in group B underwent repeat operation for recurrent uterovaginal or vault prolapse. CONCLUSION: Sacrospinous cervicocolpopexy with uterine conservation is a safe and effective surgical option that could benefit elderly patients with uterovaginal prolapse. It avoids the potential morbidity of vaginal hysterectomy and is associated with a high success rate.     

Collagen content of nonsupport tissue in pelvic organ prolapse and stress urinary incontinence

OBJECTIVE: Reduction in the collagen content of the pelvic floor tissue of the patients with pelvic organ prolapse and/or stress urinary incontinence has been documented previously. However, this is less clear for nonsupport tissue. We aimed to compare the collagen content of the uterine cervix, a nonsupport tissue, of women who had pelvic organ prolapse with and without stress urinary incontinence against those without these problems. STUDY DESIGN: Cervical collagen content was compared between 14 women who had pelvic organ prolapse with and without stress urinary incontinence and 17 controls without these conditions. Specimens were obtained after surgery for benign gynecologic conditions. RESULTS: Groups were similar with respect to age, parity, body mass index, and tobacco use. Women who had pelvic organ prolapse with and without stress urinary incontinence possessed significantly less collagen compared with the controls (8.10%+/-3.43% vs 12.35%+/-4.72%, P=.0104). Furthermore age, parity, body mass index, or tobacco use had no significant relationship to collagen content. CONCLUSION: Cervical collagen content is significantly decreased in women who have pelvic organ prolapse with and without stress urinary incontinence regardless of age, parity, body mass index, or tobacco use.     

Long-term results of prolapse recurrence and functional outcome after vaginal hysterectomy

ObjectiveTo evaluate the incidence of prolapse and prolapse-related symptoms following vaginal hysterectomy.MethodsData were reviewed from women who underwent vaginal hysterectomy between 1988, and 1995, at St George's Hospital, London, UK, and attended long-term follow-up. Outcome measures included a questionnaire for prolapse, urinary, bowel, and sexual symptoms; and a vaginal examination.ResultsAmong 94 women attending long-term evaluation, the mean follow-up time was 100.7 months (range 67.0–156.0 months). Before vaginal hysterectomy, urgency was noted among 23 (24.5%), urge incontinence among 11 (11.7%), and stress incontinence among 8 (8.5%) women. At follow-up, these symptoms were observed among 23 (24.5%), 13 (13.8%), and 6 (6.4%) women, respectively. De novo urge incontinence and de novo stress incontinence were observed among 3 (3.2%) and 2 (2.1%) women, respectively. Vaginal examination data were compared for 70 women, of whom 18 (25.7%) had grade 1, 40 (57.1%) had grade 2, and 6 (8.6%) had grade 3 uterine prolapsed before surgery. Postoperatively, vaginal vault prolapse occurred in 7 (10.0%) women and correlated with degree of posterior prolapse (P = 0.007), but not with severity of uterine descent (P = 0.205) or previous prolapse surgery (P = 0.573).ConclusionThe incidence of post-hysterectomy vault prolapse correlated with the degree of preoperative rectocele.     

Laparoscopic suture hysteropexy for uterine prolapse

OBJECTIVE: Vaginal hysterectomy remains the accepted surgical treatment for women with uterine prolapse. The Manchester repair is favored in women wishing uterine preservation. Vaginal hysterectomy alone fails to address the pathologic cause of the uterine prolapse. The Manchester repair has a high failure rate and may cause difficulty sampling the cervix and uterus in the future. The laparoscopic suture hysteropexy offers physiologic repair of uterine prolapse. METHOD: At the laparoscopic suture hysteropexy, the pouch of Douglas is closed and the uterosacral ligaments are plicated and reattached to the cervix. RESULTS: Forty-three women with symptomatic uterine prolapse were prospectively evaluated and underwent laparoscopic suture hysteropexy with a mean follow-up of 12 +/- 7 months (range 6-32). The mean operating time for the laparoscopic suture hysteropexy alone was 42 +/- 15 minutes (range 22-121), and the mean blood loss was less than 50 mL. On review, 35 women (81%) had no symptoms of prolapse and 34 (79%) had no objective evidence of uterine prolapse. Two women subsequently completed term pregnancies and were without prolapse. Both underwent elective cesarean delivery. CONCLUSION: The laparoscopic suture hysteropexy is effective and safe in the management of symptomatic uterine prolapse. The result is physiologically correct, without disfiguring the cervix. This may be an appropriate procedure for women with uterine prolapse wishing uterine preservation.     

Treatment of vaginal vault prolapse with abdominal sacral colpopexy using prolene mesh

BACKGROUND: We report our experience on abdominal sacral colpopexy (CSP) with a prolene mesh in women with vaginal vault prolapse. METHODS: From 1994 to 1997 15 patients (average 57 years), underwent CSP. All patients suffered from a serious vaginal vault prolapse. Eight of them also had a uterine prolapse. Seven patients had already been operated for hysterectomy (5 vaginal, 2 abdominal). Four of them had already been operated for urinary incontinence: (3 Raz, 1 Burch). In 6 cases we have a colposuspension according to Burch associated with CSP. Average follow-up was 15 months. RESULTS: All the patients have carried a bladder catheter for 4-12 days (average 5 days). The patients who were sexually active have begun having normal sexual intercourse again. Neither relapses of the treated prolapses, no infections or rejections of the prosthesis have been verified. In 1 patient pollakiuria insensitive to anticholinergics has persisted. Four patients have complained of hypogastric "sense of weight", without any clinical evidence of pathology. CONCLUSION: Our survey confirms the information and the good result of this technique in the treatment of the total vaginal dome prolapse, also in comparison with our operations for sacrospinosous ligament fixation. This kind of treatment through the vagina, is not always possible, above all after hysterectomy with a very short vagina.     

Changing the route of hysterectomy: the results of a policy of attempting the vaginal approach in all cases of dysfunctional uterine bleeding

OBJECTIVE: To assess the effectiveness of a policy of performing a vaginal hysterectomy for as many cases of dysfunctional uterine bleeding without uterine prolapse as possible between 1997 and 2003. STUDY DESIGN: The study was prospective, with retrospective analysis of data. SETTING: Warwick Hospital. POPULATION: Eighty-seven women in a district hospital serving a population of 270,000 in South Warwickshire. METHODS: During 1997 and 2003, an effort was made to perform as many hysterectomies vaginally as possible, with oophorectomy where necessary, in women with dysfunctional uterine bleeding in the absence of prolapse. The trends of the three different operations, total abdominal hysterectomy, sub-total abdominal hysterectomy and vaginal hysterectomy over the 7-year period were analysed. MAIN OUTCOME MEASURES: The ability to undertake surgery successfully, complications rates, length of hospital stay and changes in surgical practice. RESULTS: Over this 7-year period, it has proved possible to change the emphasis from abdominal to vaginal hysterectomy for dysfunctional uterine bleeding. In 1997, the most common operation for dysfunctional uterine bleeding (72.7%) was subtotal hysterectomy+/-bilateral salpingo-oophorectomy, followed by (27.3%) total abdominal hysterectomy+/-bilateral salpingo-oophorectomy. No cases were undertaken vaginally. By 2003, however, the trend had completely reversed, with the only procedure undertaken being vaginal hysterectomy+/-bilateral salpingo-oophorectomy. There is no evidence that such an approach increases the complication rate, and the recovery rate from surgery is improved with a tendency towards earlier discharge in the vaginal surgery group. CONCLUSION: The vaginal approach is possible for an average gynaecologist working in a district general hospital, with no additional complications and an improved recovery rate for patients.     

女性盆腔脏器脱垂门诊患者临床特征分析

目的 调查女性盆腔脏器脱垂门诊患者的临床特征,了解主要症状的患病率及联合患病率,以及症状与脱垂部位、脱垂程度的关系.方法 选取2009年11月至2010年4月在北京大学人民医院和航天中心医院妇科门诊因盆腔器官脱垂患者105例,按照现况调查方法进行现场问卷调查和妇科检查.结果 发放问卷105份,全部回收,结果显示:①平均...