Vaginal versus transabdominal hysterectomy: is mode of hysterectomy to influence pelvic statics or is pelvic statics to influence mode of hysterectomy?
BACKGROUND
To check the hypothesis that the mobility of the urethrovesical junction in the preoperative phase is different in women that will undergo either vaginal, abdominal, or laparoscopic-assisted vaginal hysterectomy.


METHODS
Eighty-seven consecutive hysterectomies, carried out between January 1999 and December 2001 in our Department, were retrospectively considered. The type of surgical procedure as well as the approach was decided by the surgeon, according to personal experience. Each patient underwent a preoperative transperineal ultrasound, measuring urethral mobility. The ultrasounds were repeated 1 month and 1 year after surgery.


RESULTS
In 35 out of 36 women (97.2%) that underwent vaginal hysterectomy and in nine out of 12 (75%) that underwent laparoscopic-assisted vaginal hysterectomy, we detected a high level of urethral mobility in the preoperative phase, compared with nine out of 39 (23.1%) women that underwent transabdominal hysterectomy.


CONCLUSIONS
The results of our study allow us to confirm our starting hypothesis. Statistical analysis highlights that preoperative data are significantly different for the three types of hysterectomies, both as urethral mobility values (analysis of variance P<or=0.0001) and as relative frequency of patients at higher risk of pelvic statics alterations (chi2 test P<or=0.0001).
Costantini
Sergio
S
Department of Obstetrics and Gynecology, University of Genoa, Genoa, Italy. costante@unige.it
Mistrangelo
Emanuela
E
Francioso
Raffaella
R
Valenzano Menada
Mario
M
Risso
Domenico
D
Lantieri
Pasquale
P
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000209:etiology*