Management of uterine prolapse: vaginal hysterectomy versus uterus preserving procedures
Keywords:Uterine Prolapse; Hysterectomy, Vaginal; Pelvic Floor; Pelvic Pain; Urinary Incontinence.
Pelvic organs prolapse is a disease in which one or more of the female pelvic organ like bladder, uterus, rectum, intestines or vaginal vault descend through the vagina. Uterus preserving procedures and vaginal hysterectomy were compared for success of repair, duration of surgery and stay, blood loss, and post operative complications especially in older women.
Material and methods
This study was conducted in Gynae and Obstetrics unit C of Ayub teaching hospital Abbottabad for the period of two years and 3 months from October 2018 till December 2021. Sample size was calculated and all the subjects who fulfilled the inclusion criteria underwent a complete workup including history and examination. Data collected on predesigned proforma including demographic variables, obstetrical history, history of any illness, type of prolapse, type of procedure, duration of surgery and stay in hospital, amount of blood loss, type of anaesthesia and postoperative complications. All participants were assigned to either vaginal hysterectomy or uterus preserving procedures. Data was analysed by SPSS version 10.
Out of 73 patients, 41 had vaginal hysterectomy and AP repair and 32 patients had uterus preserving procedures. Mean duration of surgery for vaginal hysterectomy was 68 minutes and for uterus preserving procedures was 40 minutes. Mean blood loss for vaginal hysterectomy was 291 ml and for uterus preserving procedures was 155ml. Mean duration of hospital stay for vaginal hysterectomy was 5 days and for uterus preserving procedures was 3.5 days. Six patients had complications with vaginal hysterectomy and 5 patients had complications in uterus preserving procedures.
The advantage of uterus preserving procedures over vaginal hysterectomy is that it maintains pelvic anatomy integrity and duration of surgery, blood loss and hospital stay are significantly reduced and can be safely used in older women too.
Key words: uterovaginal prolapse, vaginal hysterectomy, uterus preserving procedures, modified Purandere’s procedure, cervicopexy.