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Southern Medical Journal Aug 1965
Topics: Carcinoma in Situ; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Neoplasm Recurrence, Local; Neoplasms; Postoperative Care; Postoperative Complications; Surgical Procedures, Operative; Suture Techniques; Uterine Cervical Neoplasms; Vagina
PubMed: 14315428
DOI: 10.1097/00007611-196508000-00001 -
Archives of Gynecology and Obstetrics Aug 2003The objectives were to determine the incidence, indications, associated risk factors and complications with emergency peripartum hysterectomy at King Abdulaziz...
OBJECTIVES
The objectives were to determine the incidence, indications, associated risk factors and complications with emergency peripartum hysterectomy at King Abdulaziz University Hospital, Saudi Arabia.
METHODS
This is a retrospective analysis of 17 cases of emergency peripartum hysterectomy done from January 1, 1991 to December 31, 2002.
RESULTS
Seventeen patients of emergency peripartum hysterectomy were identified among 34,379 deliveries and the incidence rate was 0.5 per 1,000. Uterine atony 11 (64.7%, 9 without previa and 2 with previa) and followed by morbid adherent placenta with previa 6 (35.3%, 1 complete placenta accreta and 5 partial adherent placenta) was the most common indication of hysterectomy. Of the atonic group, 3 were primigravidae, 2 of 3 induced and 1 placenta previa. In morbid adherent placenta group the gravidity, previous abortions and prior cesarean deliveries were higher compared to the atonic group and were statistically significant. Conservative surgery performed in 6 (35.3%) patients before proceeding to hysterectomies, 3 (17.7%) patients had uterine artery ligation and 3 (17.7%) internal iliac ligation. Eight (47.1%) hysterectomies were subtotal. Nine (53%) patients developed disseminated intravascular coagulopathy (DIC) and one case (6%) had bilateral ureteric ligation and bladder injury. No maternal deaths occurred.
CONCLUSION
Uterine atony still is the leading cause of primary postpartum hemorrhage and the main indications of emergency peripartum hysterectomy. The combination of high parity, cesarean section, prior cesarean delivery and current placenta previa were identified as risk factors, and should alert the obstetrician that an emergency peripartum hysterectomy may needed. Although no maternal mortality occurred morbidity remained high.
Topics: Adult; Cesarean Section; Emergency Treatment; Female; Humans; Hysterectomy; Incidence; Medical Records; Obstetric Labor Complications; Parity; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors; Saudi Arabia
PubMed: 12756583
DOI: 10.1007/s00404-003-0494-9 -
Taiwanese Journal of Obstetrics &... May 2022To clarify whether "low-risk total PP" patients bleed more than partial/marginal PP patients.
OBJECTIVE
To clarify whether "low-risk total PP" patients bleed more than partial/marginal PP patients.
MATERIALS AND METHODS
The retrospective cohort study was performed involving patients with PP between April 2006 and December 2018. The placental position was determined by ultrasound. From medical charts, the backgrounds as well as obstetric and neonatal outcomes of PP patients were retrieved.
RESULTS
This study included 349 patients with PP, which was classified into three types according to the distance between the placenta and internal ostium: total (n = 174), partial (n = 52), and marginal (n = 123) PP. In total PP patients, three factors (prior CS, anterior placenta, and placental lacunae on ultrasound) significantly increased blood loss at CS, the need for hysterectomy, homologous transfusion (≥10 U), and ICU admission. No significant difference was observed in bleeding-related poor outcomes (rate of blood loss ≥2000 mL, amount of homologous transfusion, need for hysterectomy, and ICU admission) between total PP patients without all three factors: "low-risk total PP patients" and partial/marginal PP patients (19.8 vs. 17.1%; p = 0.604, 3.7 vs. 1.1%; p = 0.330, 1.2 vs. 1.1%; p = 1.000, and 1.2 vs. 1.1%; p = 1.000, respectively).
CONCLUSION
Prior CS, anterior placenta, and placental lacunae on ultrasound were risk factors for a bleeding-related poor outcome in total PP patients. Total PP patients without these three factors showed the same bleeding-related poor outcome as partial/marginal PP patients.
Topics: Female; Hemorrhage; Humans; Infant, Newborn; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 35595436
DOI: 10.1016/j.tjog.2022.03.007 -
American Journal of Obstetrics and... Jul 1977Bladder dysfunction is a common occurrence following radical hysterectomy. We studied bladder function prospectively in 10 patients before and after radical...
Bladder dysfunction is a common occurrence following radical hysterectomy. We studied bladder function prospectively in 10 patients before and after radical hysterectomy. Results suggest that the hypertonic phase observed immediately postoperatively is the result of an increase in myogenic tonicity of the detrusor muscle secondary to the trauma of operation and prolonged catheter drainage. The inability of patients to urinate effectively is due to partial detrusor denervation. Combined cystometry and electromyography confirmed the presence of normal sphincter function and the absence of detrusor sphincter dyssynergia. Prevention of postoperative bladder atony includes a careful preoperative urologic evaluation, including cystometry. Postoperative bladder care should emphasize the prevention of overdistention. Inability to empty the bladder after operation may be managed effectively by intermittent self-catheterization, Urecholine, or prolonged catheter drainage. Patients should be evaluated periodically to uncover delayed bladder decompensation.
Topics: Bethanechol Compounds; Electromyography; Female; Humans; Hysterectomy; Muscle Denervation; Muscle Tonus; Postoperative Complications; Pressure; Prospective Studies; Quaternary Ammonium Compounds; Urinary Bladder; Urinary Bladder Diseases; Urinary Catheterization; Urination Disorders
PubMed: 18009
DOI: 10.1016/0002-9378(77)90211-3 -
Ontario Health Technology Assessment... 2023Robotic-assisted surgery has been used in Ontario hospitals for over a decade, but there is no public funding for the robotic systems or the disposables required to...
BACKGROUND
Robotic-assisted surgery has been used in Ontario hospitals for over a decade, but there is no public funding for the robotic systems or the disposables required to perform robotic-assisted surgeries ("robotics disposables"). We conducted a health technology assessment of robotic-assisted hysterectomy (RH) for the treatment of endometrial cancer in people with obesity. Our assessment included an evaluation of the effectiveness, safety, and cost-effectiveness of RH, as well as the 5-year budget impact for the Ontario Ministry of Health of publicly funding RH. It also looked at the experiences, preferences, and values of people with endometrial cancer and obesity, as well as those of health care professionals who provide surgical treatment for endometrial cancer.
METHODS
We performed a systematic literature search of the clinical evidence to identify systematic reviews and randomized controlled trials relevant to our research question. We reported the risk of bias from the included systematic review. We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search. We also analyzed the 5-year budget impact of publicly funding RH (including total, partial, and radical procedures) for people with endometrial cancer and obesity in Ontario. To contextualize the potential value of RH for people with endometrial cancer and obesity, we spoke with people with lived experience of endometrial cancer and obesity who had undergone minimally invasive surgery (either laparoscopic hysterectomy [LH] or RH), and we spoke with gynecological cancer surgeons who perform hysterectomy.
RESULTS
We included one systematic review in the clinical evidence review. An indirect comparison showed that conversion rates to open hysterectomy (OH) were similar for LH and RH in patients with a body mass index (BMI) ≥ 30 kg/m (6.5% vs. 5.5%, respectively) (GRADE: Very low). An indirect comparison within a subset of patients with a body mass index (BMI) ≥ 40 kg/m showed that a higher proportion of patients who underwent LH required conversion to OH compared with patients who underwent RH (7.0% vs. 3.8%, respectively) (GRADE: Very low). Rates of perioperative complications were similarly low for both LH and RH (≤ 3.5%) (GRADE: Very low). We identified two studies that met the inclusion criteria of our economic literature review. The included economic studies found RH to be more costly than OH or LH for endometrial cancer; however, because these studies were conducted in other countries, the results were not applicable to the Ontario context. Assuming a moderate increase in the volume of robotic-assisted surgeries, our reference case analysis showed that the 5-year budget impact of publicly funding RH for people with endometrial cancer and obesity would be $1.14 million. The budget impact analysis results were sensitive to surgical volume and the cost of robotics disposables. The people we spoke with who had lived experience of endometrial cancer and obesity, as well as gynecological cancer surgeons, spoke favourably of RH and its perceived benefits over OH and LH for people with endometrial cancer and obesity.
CONCLUSIONS
Compared with LH, RH is associated with fewer conversions to OH in patients with endometrial cancer and obesity (i.e., those with a BMI ≥ 40 kg/m). Rates of perioperative complications were similarly low for both LH and RH. The cost-effectiveness of RH for people with endometrial cancer and obesity is unknown. We estimate that the 5-year budget impact of publicly funding RH for people with endometrial cancer and obesity would be $1.14 million. People we spoke with who had lived experience of endometrial cancer and obesity reported favourably on their experiences with minimally invasive hysterectomy (either LH or RH) and emphasized the importance of the availability of safe surgical options for people with obesity. Gynecological surgeons perceived RH as a superior alternative to OH and LH for people with endometrial cancer and obesity.
Topics: Female; Humans; Robotic Surgical Procedures; Technology Assessment, Biomedical; Endometrial Neoplasms; Cost-Benefit Analysis; Laparoscopy; Hysterectomy
PubMed: 38026449
DOI: No ID Found -
The Lancet. Oncology Aug 2007
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Female; Fertility; Humans; Hysterectomy; Pregnancy; Trophoblastic Tumor, Placental Site; Uterine Neoplasms
PubMed: 17679085
DOI: 10.1016/S1470-2045(07)70243-7 -
European Journal of Obstetrics,... May 2016To characterize the etiologies of adnexal masses requiring reoperation in women with prior hysterectomy and to compare incidence and pathology of these masses based upon...
OBJECTIVES
To characterize the etiologies of adnexal masses requiring reoperation in women with prior hysterectomy and to compare incidence and pathology of these masses based upon whether total, partial or no adnexectomy was performed at time of hysterectomy. In addition, the average time interval between hysterectomy and reoperation for a pelvic mass is ascertained.
STUDY DESIGN
A single-institution, retrospective review spanning 10 years. Using pertinent ICD-9 and CPT codes, women with a history of hysterectomy who underwent a subsequent surgery for an adnexal or pelvic mass were identified.
RESULTS
Over ten years, 250 women returned for gynecologic surgery due to a pelvic mass after prior hysterectomy. Most had undergone hysterectomy only (76%). 64.8% of these women had masses of ovarian origin, 12.4% were tubal in origin, 20% of masses involved both the ovary and tube and a small proportion arose from non-gynecologic processes. 18% of these women had a malignancy; 80% were ovarian and 6.7% originated from the fallopian tube. Patients having had a prior hysterectomy and bilateral salpingectomy returned soonest (p<0.0001) and patients with malignant masses returned after the longest time intervals (HR 0.41, p<0.0001).
CONCLUSIONS
The majority of adnexal masses requiring reoperation after hysterectomy are gynecologic in origin, benign, and arise from the ovary. Women returning with malignant masses after hysterectomy present after longer time intervals.
Topics: Adnexal Diseases; Adult; Aged; Fallopian Tube Neoplasms; Fallopian Tubes; Female; Gynecologic Surgical Procedures; Humans; Hysterectomy; Middle Aged; Ovarian Neoplasms; Ovary; Retrospective Studies; Salpingectomy; Time Factors
PubMed: 27031192
DOI: 10.1016/j.ejogrb.2016.02.043 -
Archives of Gynecology and Obstetrics Oct 2012Currently, controversy exists with regard to the duration of bladder drainage and choice of catheter used in women who undergo radical hysterectomy. In this manuscript,...
PURPOSE
Currently, controversy exists with regard to the duration of bladder drainage and choice of catheter used in women who undergo radical hysterectomy. In this manuscript, we propose a novel approach to improving postoperative bladder care in women who undergo radical hysterectomy.
METHODS
This is a retrospective study of women who underwent Type 3 Piver radical hysterectomy in a gynaecological oncology centre in the United Kingdom from January 2009 to September 2011. We report the outcomes of removal of urinary catheter 48-72 h following radical hysterectomy.
RESULTS
Over a 32-month period, 30 women underwent radical hysterectomy. 19 (63.3 %) women underwent surgery for treatment of cervical cancer, 5 (16.7 %) women for management of endometrial cancer, 6 (20 %) women for other conditions. One patient underwent partial cystectomy at the time of radical hysterectomy and was not included in the analysis. Of the 29 patients, only five (17.2 %) were found to have urinary residuals greater than 100 ml following the removal of the indwelling catheter on the second postoperative day and required recatheterisation. 82.8 % of the patients had the catheter removed within 48-72 h postoperatively. None of these patients required re-admission with urinary retention.
CONCLUSION
Removal of urinary catheter on the second postoperative day following radical hysterectomy is feasible and not associated with increased morbidity. This approach may be particularly useful to complement the introduction of laparoscopic and robotic surgical approaches for surgical management of cervical cancer.
Topics: Adult; Female; Humans; Hysterectomy; Middle Aged; Postoperative Care; Retrospective Studies; Time Factors; Urinary Catheterization
PubMed: 22648448
DOI: 10.1007/s00404-012-2393-4 -
International Journal of Gynecological... Mar 2012The objectives of the study were to investigate the role of and indications for adjuvant hysterectomy in patients with high-risk gestational trophoblastic neoplasia.
OBJECTIVES
The objectives of the study were to investigate the role of and indications for adjuvant hysterectomy in patients with high-risk gestational trophoblastic neoplasia.
METHODS
We retrospectively analyzed records of patients identified as having undergone adjuvant hysterectomy for high-risk gestational trophoblastic neoplasia at First Hospital of Xi'an Jiaotong University, Xi'an, China, between 1985 and 2005. Therapeutic response was defined as complete with normalization of human chorionic gonadotropin (hCG) concentration, partial response with a decrease of more than 50%, and no response with a decrease of 50% or less. Complete remission was defined as normal hCG at 3 consecutive weekly assays without clinical evidence of disease.
RESULTS
A total of 21 patients (72.4%) showed an initial therapeutic response after surgery and 8 (27.6%) had no response. The initial therapeutic response was complete in 8 patients (27.6%) and partial in 13 (44.8%). During follow-up of 6 to 168 months, all 21 patients with an initial response and 2 of 8 patients without an initial response ultimately achieved complete remission (23 of 29 patients, 79.3%). Three patients (10.3%) had recurrence after primary remission; 2 patients (6.90%) died. Metastases outside of lungs or pelvic organs, number of metastases, presurgery chemoresistance to multidrug regimens, especially with 2 or more failed protocols, were considered possible reasons for decreased effectiveness of hysterectomy.
CONCLUSIONS
Our study suggests that timely adjuvant hysterectomy is likely to benefit cautiously selected patients with high-risk gestational trophoblastic neoplasia. Although preoperative metastases limited to pelvic organs or lungs should not be considered an absolute contraindication, adjuvant hysterectomy should generally not be performed in the presence of distant metastases beyond the pelvic organs and lungs.
Topics: Adult; Combined Modality Therapy; Female; Follow-Up Studies; Gestational Trophoblastic Disease; Humans; Hysterectomy; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Pregnancy; Retrospective Studies; Risk; Young Adult
PubMed: 22315093
DOI: 10.1097/IGC.0b013e31823f88e2 -
The Journal of Reproductive Medicine Mar 1994Molar pregnancy is composed of two separate entities, partial (PHM) and complete (CHM), which are distinct in terms of epidemiology, genetics, histopathology, clinical... (Review)
Review
Molar pregnancy is composed of two separate entities, partial (PHM) and complete (CHM), which are distinct in terms of epidemiology, genetics, histopathology, clinical presentation and risk of persistent gestational trophoblastic tumor (GTT). The most common presenting symptom in patients with CHM is vaginal bleeding. Approximately half the patients with CHM show signs of exuberant trophoblastic growth, with uterine enlargement and high levels of human chorionic gonadotropin (hCG). In contrast, patients with PHM usually present as though they have an incomplete or missed abortion, with bleeding, small uteri and low hCG levels. Cytogenetically, all chromosomal material in CHM is derived from the male. Hence, no fetal parts are identified. In PHM, dispermy results in a triploid conceptus, in which an abnormal fetus is present and ultimately dies. The diagnosis of CHM is usually confirmed by sonography when a vesicular pattern is noted. The ultrasound pattern in PHM is less consistent and depends on careful measurement of the gestational sac. Patients with CHM with marked trophoblastic hyperplasia, elevated hCG levels and enlarged uteri can develop significant medical complications, which should be recognized early and treated aggressively. These include acute respiratory distress syndrome, hyperthyroidism, preeclampsia and theca lutein cysts. All molar pregnancies should be evacuated promptly following a definitive diagnosis. If the patient no longer wishes to preserve her fertility, a hysterectomy will reduce the risk of developing nonmetastatic GTT. Following evacuation, careful hCG monitoring is mandatory since it is the most reliable and sensitive method for the early detection of GTT.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Abortion, Incomplete; Abortion, Missed; Abortion, Therapeutic; Aftercare; Chorionic Gonadotropin; Female; Humans; Hydatidiform Mole; Hyperthyroidism; Hysterectomy; Ovarian Neoplasms; Pre-Eclampsia; Pregnancy; Preoperative Care; Respiratory Distress Syndrome; Risk Factors; Sensitivity and Specificity; Thecoma; Ultrasonography, Prenatal; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 8035368
DOI: No ID Found