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hysterectomy

Indications: - uterine disease - uterine cancer - abnormal uterine bleeding - uterine fibroids - chronic pelvic pain - endometriosis Epidemiology: - most common gynecologic surgery in U.S. [10] - 23% of black women, 21% of white women [13] - many surgeries unnecessary or not indicated - alternative treatments underutilized [10] Procedure: - surgical removal of the uterus - laparoscopic & vaginal hysterectomy widely used - uterine morcellation not recommended Complications: - may be associated with increased risk of cardiac disease [3] - elevated risk for cardiovascular disease & overall mortality with bilateral salpingo-oophorectomy (BSO) [6] - no difference in fatal or nonfatal cardiac events, stroke or hip fracture with ovarian conservation [7] - hysterectomy with or without bilateral salpingo-oophorectomy is not associated with increased cardiovascular risk [9] - uterine morcellation during laparoscopic hysterectomy may increase risk for metastasis of undiagnosed uterine cancer Management: - ovarian conservation until at least age 65 may benefit long-term survival for women undergoing hysterectomy for benign disease & who are not at increased risk of ovarian cancer [5] - no evidence supports routine pelvic exams & vaginal cuff PAP smears in women who have had a hysterectomy for benign conditions - cystoscopy after hysterectomy may be of benefit in preventing urologic injuries [11] Notes: - sexual pleasure may improve after hysterectomy [2] - supracervical hysterectomy no better than total hysterectomy for sexual function [4] - robotic hysterectomy is best used for unusual & complex clinical conditions [8] - ovarian reserve declines faster after hysterectomy than in women with intact reproductive tracts [12]

Related

uterine morcellation

Specific

hysterectomy with salpingo-oophorectory & omectomy total abdominal hysterectomy (TAH)

General

gynecologic surgery

References

  1. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  2. Journal Watch 23(23):184, 2003 Roovers-J-PWR et al, BMJ 327:774, 2003 PMID: 14525872 http://bmj.com/cgi/content/full/327/7418/774
  3. Internal Medicine News, June 2005, pg 22 cites evidence from the Women's Health Initiative study
  4. Journal Watch 25(16):131, 2005 Kuppermann M, Summitt RL Jr, Varner RE, McNeeley SG, Goodman-Gruen D, Learman LA, Ireland CC, Vittinghoff E, Lin F, Richter HE, Showstack J, Hulley SB, Washington AE; Total or Supracervical Hysterectomy Research Group. Sexual functioning after total compared with supracervical hysterectomy: a randomized trial. Obstet Gynecol. 2005 Jun;105(6):1309-18. PMID: 15932822
  5. Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. Ovarian conservation at the time of hysterectomy for benign disease. Obstet Gynecol. 2005 Aug;106(2):219-26. PMID: 16055568
  6. Parker WH et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses' Health Study. Obstet Gynecol 2009 May; 113:1027. PMID: 19384117
  7. Jacoby VL et al. Oophorectomy vs ovarian conservation with hysterectomy: Cardiovascular disease, hip fracture, and cancer in the Women's Health Initiative Observational Study. Arch Intern Med 2011 Apr 25; 171:760. PMID: 21518944 - Arnold LD and Colditz GA. Hysterectomy with oophorectomy: Implications for clinical decision making. Arch Intern Med 2011 Apr 25; 171:768. PMID: 21518945
  8. ACOG President James T. Breeden, MD Statement on Robotic Surgery March 14, 2013 http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Statement_on_Robotic_Surgery
  9. Physician's First Watch, May 15, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society - Matthews KA, Gibson CJ, El Khoudary SR, Thurston RC. Changes in Cardiovascular Risk Factors by Hysterectomy Status with and without Oophorectomy: Study of Women's Health across the Nation. J Am Coll Cardiol. 2013 May 15 PMID: 23684687
  10. Corona LE et al. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Am J Obstet Gynecol 2015 Mar; 212:304.e1 PMID: 25542564 http://www.ajog.org/article/S0002-9378%2814%2902355-2/abstract
  11. Chi AM, Curran DS, Morgan DM, Fenner DE, Swenson CW. Universal cystoscopy after benign hysterectomy: Examining the effects of an institutional policy. Obstet Gynecol 2016 Feb; 127:369 PMID: 26942367 http://journals.lww.com/greenjournal/Abstract/2016/02000/Universal_Cystoscopy_After_Benign_Hysterectomy_.27.aspx
  12. Trabuco EC et al. Association of ovary-sparing hysterectomy with ovarian reserve. Obstet Gynecol 2016 Apr 4; PMID: 27054925
  13. Beavis AL, Gravitt PE, Rositch AF et al Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. Cancer. Jan 23, 2017 PMID: 28112816 http://onlinelibrary.wiley.com/doi/10.1002/cncr.30507/abstract - Dalton HJ, Farley JH Racial disparities in cervical cancer: Worse than we thought. Cancer. Jan 23, 2017 PMID: 28112811 http://onlinelibrary.wiley.com/doi/10.1002/cncr.30501/abstract