The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9-45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.

Introduction The objective of the study was to investigate whether outpatient total laparoscopic hysterectomy (TLH) could be performed as a routine without compromising patient satisfaction. The main outcomes were patient satisfaction with length of hospital stay, quality of life, complications and readmissions, and time to return to work. Material and methods A non‐blinded prospective randomized controlled trial (Canadian Task Force classification I) performed in a single‐center teaching hospital in Denmark. A total of 204 women scheduled for TLH on benign indication were randomized to same‐day discharge or overnight stay after TLH. Visual analogue scales (VAS), a validated questionnaire EQ‐5D, and a diary were filled in pre‐ and postoperatively. VAS scores on satisfaction with length of hospital stay and pain were administered taken with the EQ‐5D and the diary during a follow up over 4 weeks. Student's t test, Chi‐square and non‐parametric statistics were used for analysis. The study was registered with ClinicalTrials.gov #NCT02933047. Results A total of 204 women gave informed consent and 203 underwent surgery (101 outpatient and 102 inpatient women). Complete data were available for 76 women in the outpatient group and 86 women in the inpatient group. There were no differences in baseline characteristics. No group differences were found in satisfaction with length of hospital stay (P = 0.35). The EQ‐5D revealed no difference in patient satisfaction. However, one‐third in the outpatient group chose overnight stay without medical indication. The groups were comparable in clinical outcomes. Sick leave was longer in the outpatient group regardless of the actual treatment (P = 0.015). Conclusions Routine outpatient TLH implies that one‐third of the patients stay overnight if this option is available without medical indication. Within this context the procedure can be performed with high patient satisfaction, but may lengthen the time to return to work.

Formation of neoadventitia precedes late loss of lumen, constrictive remodeling, and formation of neointima. The time course of vascular remodeling coincides with growth of neointima rather than with changes in the adventitia.

(Abstracted from Acta Obstet Gynecol Scand 2019;98:1420–1428) The minimal invasive procedure, laparoscopic hysterectomy, is safe, has low risk of complications, and requires only a short hospital stay. Within the first 4 weeks after surgery, readmission rates as low as less than 4% have been reported.

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