Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse

Ridgeway, Beri

doi:10.1016/j.ajog.2015.07.035

Cited by 63 publications

(34 citation statements)

References 27 publications

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“…In contrast to women with postmenopausal bleeding, women without postmenopausal bleeding, using an endometrial thickness of ≥ 5 mm has a lower sensitivity and specificity for detecting endometrial cancer [16]. Also the absence of ovarian cancer in our series is consistent with previous reports underlining the usefulness of transvaginal ultrasonography as an investigation prior to prolapse surgery [2,17]. In a study that evaluates the usefulness of transvaginal ultrasonography prior to vaginal hysterectomy Srikrishna et al found gynecological pathology in 46.6% of patients and changed the planned management in 2.9% of cases due to large fibroids and ovarian cysts [18].…”

Section: Discussionsupporting

confidence: 82%

“…There is an ongoing debate about hysterectomy in the axis of need for hysterectomy, route (robotic, laparoscopic or vaginally), usage of morcellation and total or subtotal. There are many suggestions from the media to avoid hysterectomy, which is the number one surgery women may not need, like episiotomy and heartburn surgery [2]. The decision to perform hysterectomy or not depends on several factors: age, completion of child-bearing, race, cultural beliefs, and whether one is the patient or the surgeon.…”

Section: Introductionmentioning

confidence: 99%

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The Incidence of Concomitant Precancerous Lesions in Cases Who Underwent Hysterectomy for Prolapse

Aydın¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Çalışmanın amacı pelvik organ prolapsusu nedeniyle histerektomi yapılanlarda beklenmedik jinekolojik kanseri ve prekanseröz lezyonların insidansını belirlemek böylece uterus koruyucu cerrahinin risklerini anlayabilmektir. Gereç ve Yöntem: Bu uterin prolapsus cerrahisi öncesi servikal sitoloji, transvajinal ultrasonografi ve yüksek risklilere (endometrial kalınlığı ≥5 mm olan postmenopozal kadınlar ve anormal uterin kanamalı premenopozal kadınlar) uygulanan endometrial histopatolojik incelemenin yer aldığı preoperatif değerlendirme yapılan histerektominin histopatolojik bulgularının retrospektif analizidir. Endometrial, servikal veya ovaryan kanser veya prekanseröz lezyon öyküsü bulunan hastalar ve eksik tıbbı kayıtları olan kadınlar çalışma-ya dahil edilmedi. Bulgular: Histerektomi yapılan 106 kadın vardı. Abdominal yol 22 (%21.7) vakada, vajinal yol 82 (%77.4) vakada ve laparoskopinin asiste ettiği vajinal histerektomi iki (%1.9) vakada kullanıldı. Vakaların 35' inde (%33) ooferektomi uygulandı. Histerektomi materyallerinden hiçbirinde malign histopatoloji tespit edilmedi. Premalign patoloji insidansı %7.5 (8/106) olarak bulundu. Altı kadında (%5.7) basit atipisiz endometrial hiperplazi tespit edilirken 2 kadında (%1.9) servikal intraepitelyal neoplazi tespit edildi. Tartışma: Transvajinal ultrasonografi ve yüksek riskli vakalara endometrial patolojik incelemenin dahil olduğu preopartif değerlendirme sonrasında histerektomi yapılan kadınlarda endometrial, servikal ve ovaryan malinite insidansı yok denecek kadar azdır. Düşük rüskli endometrial ve servikal prekanseröz lezyonların dahil edilmesi ile insidans artar. Bizim sonuçlarımız uterus koruyucu prolapsus cerrahisi isteyen benzer populasyona yansıtabilinmesi için önemli bilgiler sunar. Anahtar KelimelerHisterektomi; Histopatoloji; Prekanseröz; Prolapsus Abstract Aim: The aim of the study was is to assess the incidence of unexpected gynecological cancers and pre-cancerous lesions following hysterectomy for pelvic organ prolapse to better understand the risks of uterine sparing surgery. Material and Method: This was a retrospective analysis of histopathology findings after hysterectomy for uterine prolapse surgery who underwent preoperative diagnostic work including cervical cytology, transvaginal ultrasonography and endometrial histopathological examination for a high risk group (Postmenopausal women with an endometrial thickness of ≥5 mm and premenopausal women with abnormal bleeding). Patients with a history of endometrial, cervical and/or adnexal precancerous or cancerous pathological conditions and with incomplete medical records were excluded.Results: Results were taken from 106 women who underwent hysterectomy. The abdominal route was used in 22 cases (21.7 %), the vaginal route in 82 patients (77.4 %) and laparoscopic-assisted vaginal route in two (1.9 %) women. Oophorectomy was performed in 35 (33 %) cases. None of the patients had malignant histopathology specimens from hysterectomy. Total premalignant pathology incidence was 7.5 % (8/106). S...

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

The Incidence of Concomitant Precancerous Lesions in Cases Who Underwent Hysterectomy for Prolapse

Aydın¹

2016

Ann Clin Anal Med

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“…12 Abdominal sacrohysteropexy, transvaginal sacrospinous hysteropexy and/or laparoscopic sacrohysteropexy preserve fertility and allow for later successful delivery. [10][11][12][13] When we searched the literature, as similar our study, we found the number of case series were between five and eight women who got pregnant after uterus-preserving surgery in the different studies. 4,6,13 In a recent study on laparoscopic hysteropexy, six patients got pregnant; no apical prolapse was seen after delivery.…”

Section: Discussionmentioning

confidence: 55%

“…Ridgeway listed the following advantages of uterine preservation: reduced surgical time and blood loss, maintenance of fertility, later natural menopause, avoidance of an unnecessary procedure, preservation of the roles played by the uterus and cervix in terms of pelvic stability and sexual satisfaction, minimal invasiveness, more rapid recovery, decreased risk of mesh exposure, good short-term outcomes and patient preference. 10 Although some data on pregnancies after sacrohysteropexy or sacrospinous fixation are available, there are no data in the literature about pregnancies after laparoscopic pectopexy. When we searched to learn of previous delivery routes after POP surgery, although not a general rule, expert opinions were to perform CS.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes after laparoscopic pectopexy surgery: A case series

Bağlı

Tahaoğlu

2020

J of Obstet and Gynaecol

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Aim We aimed to present the outcomes of five pregnant women who had laparoscopic pectopexy in their past. Methods In this retrospective cohort study, we reviewed all female patients who underwent modified laparoscopic pectopexy between 2016 and 2018 at our hospital. Polypropylene monofilament mesh was used for the pectopexy procedure in 36 cases of women suffering from apical pelvic organ prolapse (POP). Five women were pregnant at different dates after the surgery; we included them in the study (n = 5). We collected data including age, gravidity, parity, magnetic resonance image, sonographic image, POP – Quantification scores, neonatal results from the hospital database. Results After uneventful examinations during pregnancy, four women delivered via caesarean section; one of them got pregnant again and delivered successfully. We did not see relapse in apical prolapse or other compartments 3, 6 and 12 months after delivery. All women gave high satisfaction scores regarding POP at 12 months after delivery. Conclusion Laparoscopic pectopexy is an effective and alternative procedure for women with POP and a good option for preserving fertility. We found that pregnancy did not adversely affect the short‐term success of laparoscopic pectopexy, and vice versa.

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“…Hysterectomy does not address the underlying pathophysiology of poor connective tissue support [11]. In addition to this removal of the uterus disrupts the uterosacral-cardinal ligament complex (pericervical endopelvic fascia) which may further weaken support [12]. Furthermore concomitant hysterectomy significantly increases the risk for vaginal erosion of the Mesh as the Mesh in this case is attached to the site of surgery [13][14][15].…”

Section: Commentmentioning

confidence: 99%