Freedom Updated: "2011/06/02 04:11"

By Xie Qinghong

Hysterectomy is the most commonly performed gynecological surgery. According to statistics, 8.5% of women in France and 17% in the United States undergo hysterectomy due to benign conditions such as excessive menstrual bleeding, uterine fibroids, endometriosis, benign ovarian tumors, and uterine prolapse. Epidemiological surveys in Taiwan indicate that the prevalence of hysterectomy among women aged 20–59 and those over 60 is 1.67% (59/3537) and 8.83% (134/1517), respectively.

Indications for hysterectomy in benign diseases include abnormal bleeding, uterine fibroids, adenomyosis, endometriosis, pelvic organ prolapse, pelvic inflammatory disease, chronic pelvic pain, and uterine lesions caused by pregnancy.

Malignant indications include cervical intraepithelial neoplasia (CIN), invasive cervical cancer, endometrial hyperplasia, endometrial cancer, ovarian cancer, fallopian tube cancer, and gestational trophoblastic tumors.

Statistics Show Higher Risk of Urinary Incontinence After Hysterectomy

For patients undergoing radical hysterectomy due to cancer, postoperative issues such as difficulty urinating and urinary incontinence are often anticipated. Similarly, clinical studies show that women who undergo hysterectomy for benign conditions—whether via laparoscopy, abdominal, or vaginal surgery—also face a significantly higher risk of urinary incontinence compared to the general population.

Among Taiwanese women over 60, the prevalence of urinary incontinence is 29.8% for those who have not undergone hysterectomy and 42.4% for those who have.

In addition to the increased risk of urinary incontinence, studies suggest that the uterus is positively associated with a woman's self-esteem, body image, confidence, and sexual desire. Preserving the cervix can help maintain a patient's self-image. Over the past 20 years, Western developed countries have increasingly favored subtotal hysterectomy (which retains the cervix) over total hysterectomy for treating benign uterine conditions. However, if the cervix is preserved, patients must be advised to undergo long-term follow-up Pap smears to rule out cervical malignancies.

Furthermore, for patients requiring surgical correction of uterine prolapse, uterine suspension should be prioritized. Besides reducing the risk of urinary incontinence and preserving self-image and confidence, there is no definitive clinical evidence that simple hysterectomy improves pelvic organ relaxation. Moreover, uterine suspension can be performed laparoscopically with minimal incisions, restoring the uterus to its original position and reducing hospital stays to just 1–2 days.

Since the bladder lies directly in front of and below the uterus, it is often affected by various conditions that impair bladder and urethral function. Therefore, before performing uterine surgery, it is essential to evaluate whether the patient also suffers from urinary incontinence, difficulty urinating, or frequent urination.

For patients with frequent urination, it is crucial to determine the duration of symptoms and assess urine volume per void to address these issues during surgery. Otherwise, postoperative lower urinary tract dysfunction may persist.

Conservative Treatment Over Aggressive Intervention

In summary, the new trend in uterine surgery is:
- Prefer vaginal surgery over abdominal.
- Prefer laparoscopy over laparotomy.
- Preserve the uterus whenever possible.
- Opt for conservative treatment over aggressive intervention.
- Always consider coexisting bladder and urethral dysfunction.

Gynecologists must not only master various surgical techniques but also discuss with patients based on their medical history, physical examination, and clinical findings. By adopting a "whole-person treatment" approach that prioritizes the patient's best interests, the most satisfactory outcomes can be achieved.Source: http:/ / tw. news. yahoo. com/ art……url/ d/ a/ 110602/ 78/ 2slr8. html