Do hysterectomy techniques affect sexual functions and lower urinary system complaints?

Year 2020, , 1152 - 1156, 01.12.2020

Demet Aydoğan Kırmızı , Emre Başer

https://doi.org/10.28982/josam.823448

Abstract

Aim: Hysterectomy is the most common gynecological surgical procedure. Therefore, detailed consultation about the postoperative effects of hysterectomy is an integral part of the operation. However, available data on these issues are limited and conflicting. The aim of this study is to evaluate the effects of hysterectomy types on lower urinary tract symptoms (LUTS), sexual function and quality of life.
Methods: Patients between 38-60 years of age who underwent total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and, in addition to standard total abdominal hysterectomy (TAH), uterosacral ligament-cuff suturing operation between June 2017 and 2019 were included in this cross-sectional study. Urgency, urge incontinence, frequency, abnormal emptying, hesitancy, nocturia, overflow, and interrupted stream are considered LUTS symptoms. Sexual functions were evaluated by Index of Female Sexual Function Index (FSFI) and the quality of life was evaluated by the EQ-5D (European Quality of Life Five- Dimension Scale) during the post-operative period.
Results: There was a significant decrease in urgency, urge incontinence, frequency, abnormal emptying, nocturia and interrupted stream symptoms (P<0.05) in the VH group (n=30), and urge and urge incontinence symptoms in TAH group (n=213) (P<0.05) postoperatively. In terms of the FSFI total score, the highest sexual dysfunction was in the TAH group whereas the lowest was in the TLH (n=60) group.
Conclusions: Hysterectomy does not worsen LUTS. The best post-operative sexual functions were found in the TLH group. The post-operative quality of life was better in patients operated vaginally and laparoscopically.

Keywords

vaginal hysterectomy, abdominal hysterectomy, laparoscopic hysterectomy, sexual dysfunction, lower urinary tract symptoms, quality of life

Histerektomi tekniklerinin cinsel fonksiyonlara, alt üriner sistem semptomları ve yaşam kalitesi üzerine etkisi var mıdır?

Abstract

Amaç: Histerektomi, en yaygın jinekolojik cerrahi prosedürdür. Bu nedenle, histerektominin postoperatif etkileri hakkında ayrıntılı konsültasyon operasyonun ayrılmaz bir parçasıdır. Ancak, bu konularla ilgili mevcut veriler sınırlıdır ve çelişkilidir. Bu çalışmanın amacı, histerektomi tiplerinin alt üriner sistem semptomları (LUTS), cinsel fonksiyon ve yaşam kalitesi üzerine etkilerini değerlendirmektir.
Yöntemler: Haziran 2017-2019 tarihleri arasında benign nedenlerle total laparoskopik (TLH), vajinal (VH) ve standart total abdominal histerektomi (TAH) operasyonuna ek olarak sakrouterin ligamanent-cuff sütürizasyonu yapılmış olan 38-60 yaş arasındaki hastalar bu kesitsel çalışmaya dahil edildi. Urge, urge inkontinansı, frequency, anormal boşalma, zor idrar yapma, noktüri, taşma, kesik kesik idrar yapma AÜSS semptomları olarak değerlendirildi. Sexüel fonksiyon Index of Female Sexual Function Indexi (FSFI) ve yaşam kalitesi European Quality of Life Five-Dimension Scale (EQ-5D) ölçeği ile postoperatif dönemde değerlendirildi.
Bulgular: Preoperatif döneme göre postoperatif dönemde, VH (n=30) grubunda urgency, urge incontinence, frequency, anormal boşalma, noktüri ve kesik kesik idrar yapma semptomlarında (P<0,05), TAH (n=213) hastalarında ise urge ve urge inkontinans semptomlarında anlamlı olarak azalma olduğu saptandı (P<0,05). FSFI total skoruna göre sexual disfonksiyonun en fazla TAH ve en az TLH (n=60) grubunda görüldü. En iyi genel yaşam kalitesi skorunun VH ve ardından TLH grubunda saptandı.
Sonuç: Histerektomi AÜSS’nı kötüleştirmemektedir. Vajinal yaklaşım pelvik taban onarımı imkanıyla en belirgin düzelmeyi sağlamaktadır. Post-operatif en iyi sexual fonksiyonlar TLH grubunda saptanmıştır. Vajinal ve laparoskopik olarak opere edilen hastalarda postoperatif yaşam kalitesinin daha iyi olduğu görülmektedir.

Keywords

Vajinal histerektomi, Abdominal histerektomi, Laparoskopik histerektomi, Cinsel işlev bozukluğu, Alt üriner sistem semptomları, Yaşam kalitesi

References

• 1. Clarke-Pearson DL, Geller EJ. Complications of hysterectomy. Obstet Gynecol. 2013;121(3):654-73.
• 2. Agrawal S, Chen L, Tergas AI, Hou JY, Clair CMS, Ananth CV, et al. Characteristics associated with prolonged length of stay after hysterectomy for benign gynecologic conditions. Am J Obstet Gynecol. 2018;219(1):89. e81-9.
• 3. Obstetricians ACo, Gynecologists. Choosing the route of hysterectomy for benign disease. Acog committee opinion no. 444. Obstet Gynecol. 2009;114:1156-58.
• 4. Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu Y-S, et al. Nationwide trends in the performance of inpatient hysterectomy in the united states. Obstet Gynecol. 2013;122:233-41.
• 5. Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane database of systematic reviews. 2012
• 6. Turgal M, Sivaslioglu A, Yildiz A, Dolen I. Anatomical and functional assessment of anterior colporrhaphy versus polypropylene mesh surgery in cystocele treatment. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):555-8.
• 7. Rosen CB, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R. The female sexual function index (fsfi): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208.
• 8. Group TE. Euroqol-a new facility for the measurement of health-related quality of life. Health policy. 1990;16(3):199-208.
• 9. Petros P. A ligamentous explanation for overactive bladder symptoms as defined by international continence society in the female. Central European journal of urology. 2018;71(1):105-7.
• 10. Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B. The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women. J Urol. 1993;149(6):1459-62.
• 11. Parys B, Woolfenden K, Parsons K. Bladder dysfunction after simple hysterectomy: Urodynamic and neurological evaluation. Eur Urol. 1990;17(2):129-33.
• 12. Van der Vaart C, Van der Bom J, De Leeuw J, Roovers J, Heintz A. The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms. BJOG. 2002;109(2):149-54.
• 13. Smith P, Ballantyne B. The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery. Br J Surg. 1968;55(12):929-33.
• 14. Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318-25.
• 15. Gimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A, et al. Randomised controlled trial of total compared with subtotal hysterectomy with one‐year follow up results. BJOG. 2003;110(12):1088-98.
• 16. Virtanen H, Mäkinen J, Tenho T, Kiilholma P, Pitkänen Y, Hirvonen T. Effects of abdominal hysterectomy on urinary and sexual symptoms. B J Urol. 1993;72:868-72.
• 17. Altman D, Lopez A, Falconer C, Zetterström J. The impact of hysterectomy on lower urinary tract symptoms. Int Urogynecol. J 2003;14(6):418-23.
• 18. Bohlin KS, Ankardal M, Lindkvist H, Milsom I. Factors influencing the incidence and remission of urinary incontinence after hysterectomy. Am J Obstet Gynecol. 2017;216(1):53.e1-53.e9.
• 19. Petros PE, Ulmsten U. Bladder instability in women: A premature activation of the micturition reflex. Neurourol Urodyn. 1993;12(3):235-9.
• 20. Ludwig S, Becker I, Mallmann P, Jager W. Comparison of solifenacin and bilateral apical fixation in the treatment of mixed and urgency urinary incontinence in women: Urge 1 study, a randomized clinical trial. In vivo (Athens, Greece). 2019;33(6):1949-57.
• 21. Andrada AO, De Vicente JMG, Cidre MÁJ. Pelvic plexus compression due to a uterine leiomyoma in a woman with acute urinary retention: A new hypothesis. Int Urogynecol J. 2014;25(3):429-31.
• 22. Masters W, Johnson V. Human sexual response, boston (little, brown and company) 1966.
• 23. Fox C, Fox B. A comparative study of coital physiology, with special reference to the sexual climax. Reprod. 1971;24(3):319-36.
• 24. Wierrani F, Huber M, Grin W, Henry M, Grünberger W. Postoperative libido and genital sexual sensitivity following various forms of hysterectomy. J Gynecol Surg. 1995;11(3):127-32.
• 25. Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther. 1999;25(2):81-8.
• 26. Radosa JC, Meyberg‐Solomayer G, Kastl C, Radosa CG, Mavrova R, Gräber S, et al. Influences of different hysterectomy techniques on patients' postoperative sexual function and quality of life. J Sex Med. 2014;11(9):2342-50.
• 27. He H, Yang Z, Zeng D, Fan J, Hu X, Ye Y, et al. Comparison of the short-term and long-term outcomes of laparoscopic hysterectomies and of abdominal hysterectomies: A case study of 4,895 patients in the guangxi zhuang autonomous region, china. Chinese J Cancer Res. 2016;28(2):187-96.
• 28. Kilkku P. Supra vaginal uterine amputation vs. Hysterectomy: Effects on coital frequency and dyspareunia. Acta Obstet Gynecol Scand. 1983;62(2):141-5.
• 29. Roovers J-PW, van der Bom JG, van der Vaart CH, Heintz APM. Hysterectomy and sexual wellbeing: Prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ. 2003;327(7418):774-8.
• 30. Tunuguntla HS, Gousse AE. Female sexual dysfunction following vaginal surgery: A review. J Urol. 2006;175(2):439-46.
• 31. Maas CP, Weijenborg PTM, Ter Kuile MM. The effect of hysterectomy on sexual functioning. Annu Rev Sex Res 2003;14:83-113.
• 32. Ayoubi J, Fanchin R, Monrozies X, Imbert P, Reme J, Pons J. Respective consequences of abdominal, vaginal, and laparoscopic hysterectomies on women’s sexuality. Eur J Obstet Gynecol Reprod Biol. 2003;111(2):179-82.
• 33. Ercan Ö, Özer A, Köstü B, Bakacak M, Kıran G, Avcı F. Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy. Int J Gynaecol Obstet. 2016;132(1):39-41.