hysterectomy
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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]
Indications
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]
More general terms
More specific terms
Additional terms
References
- ↑ Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ 2.0 2.1 Journal Watch 23(23):184, 2003 Roovers-J-PWR et al, BMJ 327:774, 2003 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14525872 <Internet> http://bmj.com/cgi/content/full/327/7418/774
- ↑ 3.0 3.1 Internal Medicine News, June 2005, pg 22 cites evidence from the Women's Health Initiative study
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15932822
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/16055568
- ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/19384117
- ↑ 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/21518944
Arnold LD and Colditz GA. Hysterectomy with oophorectomy: Implications for clinical decision making. Arch Intern Med 2011 Apr 25; 171:768. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21518945 - ↑ 8.0 8.1 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
- ↑ 9.0 9.1 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: https://www.ncbi.nlm.nih.gov/pubmed/23684687 - ↑ 10.0 10.1 10.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25542564 <Internet> http://www.ajog.org/article/S0002-9378%2814%2902355-2/abstract
- ↑ 11.0 11.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26942367 <Internet> http://journals.lww.com/greenjournal/Abstract/2016/02000/Universal_Cystoscopy_After_Benign_Hysterectomy_.27.aspx
- ↑ 12.0 12.1 Trabuco EC et al. Association of ovary-sparing hysterectomy with ovarian reserve. Obstet Gynecol 2016 Apr 4; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27054925
- ↑ 13.0 13.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28112816 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28112811 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/cncr.30501/abstract