Intrafascial versus extrafascial abdominal hysterectomy: effects on urinary urge incontinence

Objectives: To compare the prevalence of urological symptoms in a population of women, who had a transcervical endometrial resection (TCER) only, and a population of women, who had a TCER and a subsequent hysterectomy. The superior goal was to evaluate the possible association between hysterectomy and urinary incontinence. Design: All women, who had a TCER at our department during the period of 1990–1996 received a questionnaire with focus on urological symptoms. The answers from women, who later had a hysterectomy were compared to the answers from women, who were sufficiently treated with TCER only. Results: Of 356 women, who were alive, 16 were lost to follow-up, leaving 340 women to receive the questionnaire, which was returned by 310 women (85%). Ninety-three (31%) had a subsequent hysterectomy mainly indicated by metrorrhagia or dysmenorrhea. Of the hysterectomized women 24% reported bothersome stress incontinence against 14% in the group of women, who had TCER only (p = 0.03). No significant difference was seen with respect to urge incontinence, urgency, pollakisuria or nocturia. Significantly more women with a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to women with a slightly enlarged uterus. Conclusion:Hysterectomy is significantly associated with stress urinary incontinence in women, who previously had a TCER.

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“…In contrast to van der Vaart et al [2] and Kaya et al [3], we did not find any increased risk of urge incontinence after hysterectomy.…”

Section: Discussioncontrasting

confidence: 56%

Hysterectomy Is Associated with Stress Incontinence in Women Who Previously Had a Transcervical Endometrial Resection

Krogh¹,

Neumann²,

Lauszus³

et al. 2006

Gynecol Obstet Invest

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“…This is consistent with the rates reported in other series examining intrafascial abdominal hysterectomy, 4% in the Conde-Agudelo study 6 and 4.8% in the Kaya et al study. 12 Apart from the use of antibiotics, the low incidence of operative-site infection associated with intrafascial hysterectomy could be related to the effective hemostasis and obliteration of the dead space at the vaginal vault.…”

Section: Discussionmentioning

confidence: 99%

The Intrafascial Technique for Total Abdominal Hysterectomy: Revisiting the Valuable Classic Procedure

Charoenkwan

2015

Journal of Gynecologic Surgery

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Background: Total abdominal hysterectomy (TAH) is frequently performed for benign gynecologic conditions with the presence of a large distorted uterus and/or severe extrauterine diseases such as pelvic endometriosis or adhesion. Operative injury to adjacent organs is a major concern. Performing the procedure by using intrafascial approach has many potential benefits in preventing complications. Objective: The aim of this research was to illustrate the intrafascial technique for TAH as performed at the Faculty of Medicine, Chiang Mai University, in Chang Mai, Thailand, and to describe clinical and operative outcomes of patients with benign gynecologic conditions who underwent TAH including this technique. Materials and Methods: For this study, retrospective reviews were performed, using clinical, operative, and pathologic data from all patients who underwent TAH with the intrafascial technique for benign gynecologic conditions from January 2003 to December 2012. Descriptive statistics were used to elucidate the surgical outcomes. Results: The intrafascial technique was used in 161 patients undergoing TAH. Approximately 40% of the patients had severe pelvic pathology. All procedures were accomplished without injuries to surrounding organs. The rate of operative complications was low. Conclusions: The intrafascial technique for TAH is a simple procedure that provides many benefits including low risk of injury to surrounding structures, a well-supported vaginal vault, obliteration of dead space, and effective hemostasis. However, the procedure has been largely neglected by the gynecologic community. For modern gynecologists to be able to perform safe abdominal hysterectomy, knowledge of this intrafascial technique is crucial. ( J GYNECOL SURG 31:11)

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“…This method, which has become more popular in recent years due to its relative ease and lower blood loss, involves removal of the pericervical fascia together with the cervix. Kaya et al proposed that this step may damage paravaginal nerve bundles, resulting in denervation injury [23]. In the extrafascial technique, the endopelvic fascia is excised close to the cervix where the paravaginal nerve bundles in question are likely ranches of the uterovaginal plexus.…”

Section: Autonomic Nerve Damage In Hysterectomymentioning

confidence: 99%

Pelvic Floor Dysfunction After Hysterectomy: Moving the Investigation Forward

Chen¹,

Shackelford²,

Spain³

2021

Cureus

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The role of hysterectomy in the development of pelvic floor dysfunction (PFD) remains widely disputed. The controversy is fueled by two key factors. The first is conflicting association studies that make it difficult to establish whether a link truly exists. Although many retrospective studies report a correlation between hysterectomy and increased risk of stress urinary incontinence (SUI) or pelvic organ prolapse (POP), prospective studies often fail to replicate these results, leading some to conclude that no association exists. However, most prospective studies do not follow up for a sufficient length of time to account for the long latency of PFD and cannot unilaterally prove the absence of an association. The second source of controversy is the absence of a plausible mechanism to explain how hysterectomy could predispose patients to PFD. In this paper, we investigate autonomic innervation and smooth muscle in the three layers of pelvic floor support and propose a mechanism through which autonomic damage from hysterectomy could predispose patients to PFD. We then identify key research areas needed to evaluate this theory. This report aims to inspire a discussion on how to further the collective understanding of the relationship between hysterectomy and PFD. Clarifying the nature of this connection could have enormous consequences in redefining the risks and benefits of hysterectomy.

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Intrafascial versus extrafascial abdominal hysterectomy: effects on urinary urge incontinence

Cited by 8 publications

References 8 publications

Hysterectomy Is Associated with Stress Incontinence in Women Who Previously Had a Transcervical Endometrial Resection

Hysterectomy Is Associated with Stress Incontinence in Women Who Previously Had a Transcervical Endometrial Resection

The Intrafascial Technique for Total Abdominal Hysterectomy: Revisiting the Valuable Classic Procedure

Pelvic Floor Dysfunction After Hysterectomy: Moving the Investigation Forward

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