According to the most recent surveillance data from the CDC, hysterectomy is the second most frequently performed surgical procedure for women of reproductive age, topped only by cesarean delivery. All women considering hysterectomy should be aware of these risks prior to surgery, in order to make an informed decision as to whether the procedure is the best treatment option.
This article reviews the short- and long-term complications associated with hysterectomy and thereby aids pharmacists in providing care for this large population of women. Indications for Hysterectomy Health care providers have limited "Gonadal vein thrombosis post hysterectomy sexual dysfunction" from well-designed clinical trials to guide determination of when hysterectomy is the most appropriate treatment option.
In the case of abnormal uterine bleeding, endometrial lesions must be excluded and medical alternatives should be considered first-line therapy prior to consideration of surgical intervention. Types of Hysterectomy There are several types of hysterectomy, all of which include the removal of the uterus. In a subtotal hysterectomy also referred to as a supracervical or partial hysterectomythe upper two thirds of the uterus is removed, while the cervix is left in place.
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A total hysterectomy or complete hysterectomy involves the removal of the entire uterus as well as the cervix.
If both the ovaries and the fallopian tubes are removed during a total hysterectomy, the procedure is called a bilateral salpingo-oophorectomy. Finally, the most extreme type of hysterectomy, a radical hysterectomy, involves removal of the uterus, cervix, ovaries, fallopian tubes and, possibly, upper portions of the vagina and affected lymph glands.
In both abdominal and vaginal...
This procedure is strongly recommended for serious complications and diseases such as cancer. According to the SOGC clinical practice guidelines, vaginal hysterectomy should be considered the first choice for all benign indications, while laparoscopic-assisted approaches should be considered when using such an approach reduces the need for a laparotomy.
Surgical and Postsurgical Complications Hysterectomy is generally a safe procedure, but with any major surgery comes the risk of surgical and postsurgical complications.
Such complications commonly include infection, hemorrhage, vaginal vault prolapse, and injury to the ureter, bowel, or bladder. Postoperative fever and infection are responsible for the majority of minor complications following hysterectomy. Although some degree of cuff cellulitis probably occurs following the majority of hysterectomies, antibiotics are not required unless fever persists. Immediate catheter removal postoperatively is strongly recommended to reduce the risk of this complication.
Agents such as cefazolin, cefotetan, cefoxitin, metronidazole, and clindamycin
Gonadal vein thrombosis post hysterectomy sexual dysfunction all proved effective. Antibiotics should be continued for 24 to 48 hours after the resolution of fever and symptoms. Ureteral injury is becoming a more frequent posthysterectomy complication as the number of laparoscopic-assisted procedures increases.
The incidence rate of this complication in laparoscopic-aided procedures is 0. These injuries are best managed with resection of the damaged portion and reimplantation of the ureter. Injury to the bladder occurs in approximately 0. Several studies have concluded that partial disruption of the innervation of the bladder during hysterectomy may result in postoperative incontinence. Although bowel injury is uncommon, particularly with vaginal hysterectomy, it is a serious complication associated primarily with laparoscopic-assisted abdominal hysterectomy.
During both abdominal and vaginal surgery, the rectum and ascending and descending colon can be injured. Preoperative bowel preparations will allow for incidental colon surgery without the necessity of colostomy.
If a large bowel injury should occur and no preoperative bowel preparation was given, a temporary diverting colostomy may be indicated to protect the suture line and lower the risk of peritonitis and sepsis. One of the most serious postoperative complications associated with hysterectomy is hemorrhage. Average intraoperative blood loss can range anywhere from to
Gonadal vein thrombosis post hysterectomy sexual dysfunction. It is routine to cross-match blood in patients undergoing hysterectomy.
Two to four units of packed red blood cells should be available at all times. Women who are more likely to need blood transfusion include those undergoing peripartum hysterectomy or hysterectomy for gynecologic cancer, as well as those undergoing elective hysterectomy with pelvic inflammatory disease, or pelvic abscesses or adhesions.
The risk of venous thromboembolism following abdominal hysterectomy in low- and high-risk patients is 0. The type of prophylaxis recommended depends upon each patient's risk factors. Risk factors include obesity, malignancy, previous radiation therapy, immobilization, estrogen use, prolonged anesthesia, radical surgery, and personal or family history of thromboembolic disease.
Patients at high risk for thromboembolism may be given a low-molecular-weight heparin or 5, units of subcutaneous heparin preoperatively and then every eight to 12 hours postoperatively to reduce the risk of thromboembolic events. Fallopian tube prolapse is an uncommon postoperative complication of hysterectomy.
A predisposing factor for prolapse is the presence of a hematoma or abscess at the vaginal apex. Vaginal vault prolapse is a type of pelvic organ prolapse that can happen following surgical removal of the uterus.
It often occurs when the top of the vagina loses the support of the uterus and then sags or drops into the vaginal canal.
Most women with vaginal vault prolapse will also have bulging of the small bowel into the vagina, as well as other bladder and bowel problems such as urinary incontinence and constipation.
A rare complication that can occur following a hysterectomy is evisceration of the small intestine into the vagina. Symptoms usually include vaginal bleeding or discharge, abdominal-pelvic pain, pressure in the vagina, and protrusion of bowel. Although eviscerations usually occur early in the postoperative period, one study of 12 patients reported occurrence 27 months after various pelvic procedures.
Data show some women develop the complication, while others experience relief from the same complication. For example, some studies have shown increases in psychosexual dysfunction after hysterectomy, while others have shown improvements in this area. Many of the long-term complications associated with hysterectomy arise secondary to changes in hormonal balance.
Studies have found that even those women who keep "Gonadal vein thrombosis post hysterectomy sexual dysfunction" or both ovaries experience menopause at an earlier age. A retrospective trial found that women who had had a hysterectomy with preservation of one or both ovaries experienced menopause an average of 5.
In this study, no difference was found between women with one versus both ovaries, though some studies have reported differences.
Discusses surgery to remove the...
Initiating estrogen therapy immediately after hysterectomy with bilateral oophorectomy is important in order to prevent onset of menopausal symptoms, although some practitioners may be hesitant to prescribe long-term HT due to the findings that led to the early termination of the Women's Health Initiative WHI trial. Because this trial failed to show that estrogen protects women from coronary heart disease and demonstrated
Gonadal vein thrombosis post hysterectomy sexual dysfunction significant increases in the incidence of stroke and deep venous thrombosis, the NIH deemed it unacceptable to subject healthy women to these risks and therefore stopped the trial early.
The WHI trial also demonstrated that when estrogen replacement therapy ERT is used for the treatment of menopausal symptoms after hysterectomy, an overall balance of risks and benefits exists, and most importantly, no effect on total mortality was seen throughout the 6. Many clinicians are now using ERT through the average age of natural menopause approximately age 50 and then tapering women off therapy slowly to help prevent reappearance of symptoms.
Nonpharmacologic techniques for treating menopausal symptoms are outlined in Table 2. If a woman simply undergoes oophorectomy and her uterus is preserved, progesterone should be added to the treatment regimen to prevent endometrial hyperplasia. Studies have found that concern about posthysterectomy sexual dysfunction is the most common cause of anxiety for women undergoing the procedure.
It has been postulated that sexual function is improved through relief of pain during intercourse due to removal of pelvic pathology, relief of dysmenorrhea, and increased libido due to decreased fear of "Gonadal vein thrombosis post hysterectomy sexual dysfunction."
Vaginal hysterectomy is a procedure...
Early retrospective data found that hysterectomy causes a significant decline in sexual function. Data are also mixed concerning the effects of hysterectomy on psychological functioning. As seen with other complications of hysterectomy, retrospective studies have reported adverse psychological outcomes, whereas prospective studies have not supported these claims.
Educating women concerning the possible complications involved with hysterectomy may ease patients' preoperative anxiety and ultimately improve outcomes. Pharmacists have an important role in the care of this population of women and can aid in the prevention and treatment of complications associated with hysterectomy by providing proper education, identifying high-risk patients, and assisting with the management of medications.
Hysterectomy surveillance--United States, National Women's Health Network Web site. Accessed July 17, Accessed July 14, J Obstet Gynaecol Can.
Severe complications of hysterectomy: Ref Online Medical Database. Overview of Laparoscopic Surgery. The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms.
Hysterectomy and urinary incontinence: Urinary incontinence and hysterectomy in a large prospective cohort study in American women. Surgical approach to hysterectomy: Characteristics of patients with vaginal rupture and evisceration.
Effect of hysterectomy on conserved ovarian function. Hysterectomy and sexual functioning. Constant estrogen, intermittent progestogen vs. Int J Gynaecol Obstet. Assessing benefits and harms of hormone replacement therapy: Hormone therapy in women.
Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy. Treatment of menopausal symptoms: Hysterectomy and sexual wellbeing: Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. Psychological aspects of heavy periods: Br J Hosp Med. The psychological outcome of hysterectomy. To comment on this article, contact editor uspharmacist.
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Vaginal hysterectomy is a procedure in which the uterus is This allows the pelvic organs such as the uterus, bladder, rectum. (See "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)".) Sexual function and enjoyment, interest in sex, and pain with sex were improved for most women.
Sexual Dysfunction after Hysterectomy.
Ovarian vein thrombosis (OVT) is...
Irwin Goldstein, MD. The sexual medicine information session was held the day after our troops went into battle, but. Discusses surgery to remove the uterus to treat ovarian cancer. Covers what is done and what to expect after surgery. Looks at emotional Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus). Injury to other you may have.
To learn more, see the topic Sexual Problems in Women.
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