Long-term effects of hysterectomy due to uterine fibroids in women of reproductive age

Abstract

The article presents an analytical assessment of long-term postoperative consequences in women of reproductive age after hysterectomy for uterine fibroids. The aim of the study to determine the structure of long-term results of hysterectomy for uterine fibroids in women of reproductive age using different approaches to the possibility of optimizing the diagnostic algorithm in the preoperative period in the future. Materials and methods – 160 women aged 40 to 50 years with symptomatic uterine fibroids, who underwent hysterectomy performed by vaginal, laparoscopically assisted vaginal, abdominal, were examined. Research methods are the following: physical examination of patients, assessment of pelvic floor (cough test, Valsalva maneuver, “Stop Test” with Kegel cones), diagnosis of urogenital dysfunction using a standardized POP-Q system; instrumental examination:, complete urodynamic testing, cystometry, (for assessment of the severity of urinary incontinence the classification of the International Continence Society (ICS) was used); assessment of the patient’s quality of life on the 10th day after surgery, 3, 6, 12 months and three years after surgery using the international standard questionnaire MOS SF-36; study of the local infectious status of the female body (bacteriological and bacterioscopic examination of discharge from vagina and urethra, determination of vaginal pH Results and their discussion. The structure of distant postoperative manifestations was determined (after 36 months of postoperative monitoring): clinical manifestations of intestinal function discomfort in the same degree in patients of three subgroups, 2.4 and 2.9 times less often in group I patients indicated chronic pelvic pain, in 1.7 times less often - for genitourinary disorders, vaginal prolapse in a third of cases, especially in women with abdominal HE and classic vaginal HE (30.0±5.0 % and 37.8±5.0 %, respectively, against 17.8±4.0 % – in the group with laparotomically assisted HE). Conclusions. Given the data on genitourinary disorders and vaginal prolapse in almost a third of observations after hysterectomy for uterine fibroids, it is advisable to consider additional examination of latent signs of genitourinary syndrome at the preoperative stage to optimize the choice of access, the volume of surgical treatment.