The article presents an assessment and analysis of the most important medical and social risk factors for long-term postoperative urogenital disorders in women of reproductive age after radical surgical treatment for uterine fibroids. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, the clinical manifestations of which have a negative impact on the physical, psycho-emotional form and social significance of women in society. A survey of 80 women aged 40 to 50 years, the main group included 40 patients who underwent vaginal hysterectomy, the comparison group consisted of 40 patients with hysterectomy performed by abdominal access. Data on the assessment of pelvic floor condition and urogenital dysfunction using a standardized POP-Q system, both at the stage of preoperative observation and for 3 and 5 years after surgery. Сonducted surveys, filling diaries of pain, urination, physical examination and bimanual examination, determination of the pH of the vaginal contents, colposcopy, evaluated the index of the vaginal condition, the state of the microbiota of the mucous membranes, a comprehensive urodynamic examination, cystometry, ultrasound examination of the pelvic organs and assessment of ovarian structure.The most important risk factors are identified, which would allow to form groups of patients that require individualized approaches in the choice of surgical techniques and rehabilitation program. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth injuries, high birth parity); ovarian surgery, the use of gonadotropin-releasing hormone agonists. chronic diseases of the respiratory system and gastrointestinal tract, accompanied by increased intra-abdominal pressure; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. When choosing a method and access in case of surgical treatment for uterine fibroids, it is advisable to take into account the presence of pelvic prolapse and initial dysuric manifestations in women, the functional state of the sphincter apparatus and urethral hypermobility, obstetric and gynecological pathology and previous surgery on the organs of the uterus. the patient, her awareness of possible complications, the surgeon’s experience and his choice of surgical techniques.
The objective: to study the clinical-psychopathological features and psycho-emotional symptoms and borderline mental disorders in women of reproductive age after hysterectomy due to leiomyoma.Materials and methods. An assessment of the psychological state of 160 women after hysterectomy for leiomyoma was carried out. 90 patients of them (average age – 45.9±1.3 years old) had transvaginal hysterectomy, both classic and laparoscopically assisted one with opportunistic salpingectomy (I group) and 70 patients (average age – 47.2±1.6 years old) – abdominal hysterectomy with opportunistic salpingectomy (II group). The control group included 50 women 45.7±1.3 years old with asymptomatic leiomyoma. Clinical psychopathological, anamnestic and experimental psychological methods were used. Pathopsychological methods included methods of visual presentation of the personality profile using the Minnesota Multifaceted Personality Questionnaire. The survey was conducted at the pre-operative period, during the adaptation period and during 12 months. Statistical processing of monitoring data was carried out according to the φ-criterion using the statistical analysis software package STATISTICA v. 10 and Microsoft Office Excel application. Results. The results of the questionnaire determined that 44 (48.89 %) patients of the I group and 33 (47.14 %) women of the II group had disorders related to anxiety, and 6 (6.67 %) and 5 (7 .14 %) of the patients of both groups, respectively, were diagnosed depression before surgical treatment. After hysterectomy the number of patients with an anxiety disorder increased to 52 (57.78 %) in the I group and 41 (52.57 %) – II group, with depression – to 10 (11.11 %) and 8 (11.43 %) women, respectively. However, the psychopathological analysis with psychologists in 12 months after hysterectomy determined affective symptoms in 11 (15.7±7.0 %), and latent depression with a somatopsychic correlation, manifested by a feeling palpitation, cardialgias, vegetative disorders was found in 8 (11.4±6.0 %) cases. The type of personality accentuation influenced the development of psychoemotional manifestations. In this structure, the largest rate consisted of psychoasthenic and hysterical character traits. The age of the patient was important when analyzing additional psychological factors. Women under 44 years old associated hysterectomy with loss of femininity with premature aging of the organism. The patients with successful implementation of their role in the family and society had better postoperative psychological adaptation.Conclusions. There is a trend toward an increased number of anxiety and depressive disorders after hysterectomy in women with leiomyoma. After 12 months, affective symptoms were present in 11 (15.7±7.0 %) cases and in 8 (11.4±6.0 %) cases – hidden depression. Postoperative rehabilitation should include a consultation with a psychologist to identify and treat borderline mental disorders, which will lead to the initiation of compensatory and adaptive reactions of the body and the normalization of the psycho-emotional status.
The study examined the development of posthysterectomy syndrome in patients after hysterectomy with preservation of ovarian tissue. The aim of the study was to assess the functionality of ovarian tissue in patients with hysterectomy and opportunistic salpingectomy performed for uterine fibroids. Materials and methods of the research. The study was performed in 160 women of reproductive age. The first group included 90 patients after vaginal hysterectomy with tubectomy and associated with laparoscopy, the second group - 70 patients after abdominal hysterectomy with tubectomy. The control group included 50 women of reproductive age 45.7±1.3 years with asymptomatic fibroids. The diagnostic algorithm included assessment of hormonal status and instrumental study of structural and functional parameters of ovarian tissue both at the stage of preoperative observation and for 12 months, 3 and 5 years after surgery. Research results and their discussion. At the preoperative stage in both groups found a higher percentage of thyroid disease, hypertension and metabolic disorders, as well as combined proliferative processes of the uterus. Normal ultrasound picture of the ovaries was found in 67.8 % - in the first group and in 47.1 % - in the second group. Significant increase in blood flow in the ovarian artery, in the remote period showing atrophic changes with the development of ovarian depletion syndrome. Assessment of hormonal status in both groups shows marked changes in baseline levels of gonadotropic hormones (FSH and LH): increase in baseline FSH levels by 2.2 times, LH - 1.5 times against the control group (p <0.05), dyshormonal disorders persist for up to 5 years after surgery in one third of cases, and up to 36 months - there is an increase in the proportion of cystic and trophic changes, most pronounced in patients with reduced ovarian reserve, dysmetabolic manifestations and combined proliferative processes of the uterus and appendages before surgery, and syndrome chronic pelvic pain and venous pelvic blood supply in the postoperative period. Conclusions. The technique of performing a hysterectomy does not have a significant effect on the functional state of the ovaries in the long term. The main indicators of ovarian blood flow and steroid hormone production after hysterectomy with opportunistic salpingectomy for uterine fibroids are close to the reference values up to 36 months postoperatively
Hysterectomy, performed in reproductive age, undoubtedly causes a decrease in all parameters of quality of life and contributes to the development of imbalance of hormonal homeostasis, psycho-emotional, vegetative-neurotic symptoms, increasing sexual and urogenital dysfunction, impeding psycho-social adaptation in the family,the professional and intellectual spheres of a woman’s life. This aspect is often overlooked by surgeons when evaluating the effectiveness of treatment, although it has a significant impact on recovery from surgery. The article presents data on experimental psychological research, evaluation of the severity of urogenital dysfunction using a standardized POP-Q system, characteristics of quality of life parameters both at the stage of preoperative observation and within 1, 3 and 5 years after surgery in 80 women of reproductive age with uterine fibroids who have undergone vaginal hysterectomy. The comparison group included 60 patients with hysterectomy performed by abdominal access. According to the results of this study, in women of reproductive age after radical surgery for fibroids, it was determined that the leading violations of quality of life after hysterectomy are general somatic symptoms, psycho-emotional disorders, genitourinary and sexual disorders. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, among which the most important are urinary incontinence and prolapse, the clinical manifestations of which have a negative impact on, including the psychosocial sphere, while reducing quality of life. Today there is no consensus on the degree of impact of radical surgery for uterine fibroids on the versatility of metabolic and hormonal homeostasis, the formation of psychovegetative symptom complex, and as a consequence, the impact on quality of life, which necessitates a validated method of quality of life optimization of the rehabilitation program with personalized consideration of the leading factors of status comorbidity when planning surgical treatment. Keywords: uterine fibroids, hysterectomy, quality of life parameters.
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