title: Comparison of the Effect of Laparoscopic and Abdominal Hysterectomy on Lower Urinary Tract Function, Vaginal Length, and Dyspareunia: A Randomized Clinical Trial.
abstract: OBJECTIVE
  The effect of hysterectomy on vesicourethral and sexual functions remains controversial. The primary objective of this study was to compare the effects of a laparoscopic hysterectomy and a total abdominal hysterectomy on lower urinary tract function. The secondary aims were to compare the two surgeries in terms of postoperative vaginal length and dyspareunia.
  
  
  METHODS
  This was a prospective randomized clinical study in which 292 women were assigned to either the laparoscopic hysterectomy (n = 146) or total abdominal hysterectomy (n = 146) groups. The vaginal length and urodynamic measurements were taken, and the patients were asked to grade the presence and severity of dyspareunia using a visual analog scale 3 weeks before and 12 weeks after the surgery. The relationship between the postoperative vaginal length and the incidence of dyspareunia was evaluated. The urodynamic procedures used included uroflowmetry and voiding cystometry to record the maximum flow rate (Q-max) and to assess the bladder capacity.
  
  
  RESULTS
  The preoperative vaginal length was similar between the groups, whereas the postoperative vaginal length was significantly longer in the laparoscopic hysterectomy group. When the 15 patients who developed postoperative dyspareunia were evaluated, no differences in the postoperative vaginal length were seen, but a significant difference in the change in the length of the vagina was found when compared with the other patients. No significant difference was found with regard to pre- and postoperative Q-max, bladder capacity, and change in bladder capacity between the study groups.
  
  
  CONCLUSIONS
  The change in the length of the vagina was much more remarkable after total abdominal hysterectomy, compared with laparoscopic hysterectomy. It seems that the Q-max and the bladder capacity increase after hysterectomies, regardless of the surgical type. Further prospective randomized comparative studies are warranted to ascertain whether laparoscopic hysterectomies cause less damage to the pelvic floor, compared with abdominal hysterectomies.
authors.affiliation: 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey .
authors.forename: Mesut
authors.initials: M
authors.lastname: Polat
authors.affiliation: 2 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Istanbul University Cerrahpasa School of Medicine , Istanbul, Turkey .
authors.forename: Ilker
authors.initials: I
authors.lastname: Kahramanoglu
authors.affiliation: 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey .
authors.forename: Taylan
authors.initials: T
authors.lastname: Senol
authors.affiliation: 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey .
authors.forename: Baki
authors.initials: B
authors.lastname: Senturk
authors.affiliation: 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey .
authors.forename: Enis
authors.initials: E
authors.lastname: Ozkaya
authors.affiliation: 1 Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women Health Training and Research Hospital , Istanbul, Turkey .
authors.forename: Ates
authors.initials: A
authors.lastname: Karateke
mesh_terms: D000328:Adult; D004414:Dyspareunia / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D015994:Incidence; D010535:Laparoscopy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D011446:Prospective Studies; D014563:Urodynamics; D014621:Vagina / Q000033:anatomy & histology* / Q000601:surgery