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Objectives: This study aimed to evaluate the training and self‐assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision‐making, the surgical techniques employed, the training received, and the management of complications. Design: A cross‐sectional survey. Setting: An electronic questionnaire. Population: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members. Methods: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries. Main Outcome Measures: Demographics, surgical selection, proficiency and technique, and training methods. Results: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two‐thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10–30 cases were needed to achieve and maintain proficiency. Conclusion: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine‐sparing prolapse repairs, the decision‐making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques. [ABSTRACT FROM AUTHOR]

Background/Objectives: This systematic review aimed to evaluate the outcomes of minimally invasive techniques in gynecological cancer surgery, specifically laparoscopic hysterectomies (LHs), robotic-assisted hysterectomies (RHs), and laparoscopic-assisted vaginal hysterectomies (LAVHs). Methods: We conducted a comprehensive search of electronic databases including PubMed and MedLine from January 2010 to August 2024. The search included randomized controlled trials (RCTs) and observational studies. Studies were selected based on inclusion criteria such as a focus on LHs, RHs, or LAVHs, and reporting on key outcomes like recovery rates, overall survival (OS) rates, disease-free survival (DFS), postoperative complications, and surgery time. Exclusion criteria were applied to omit non-randomized studies, non-English publications, and those lacking relevant data. Results: The analysis included 35 studies on gynecological cancers and surgical procedures, conducted across multiple countries. Among them, 8 were RCTs from countries like the Netherlands and Italy, while 20 were retrospective cohort studies from China and the USA. The studies varied in design, cancer type, and participant age, highlighting diverse surgical approaches and the adaptation of minimally invasive techniques in gynecological cancer treatment. LH and RH demonstrated similar oncological safety with comparable OS and DFS rates. RH was associated with reduced blood loss, but longer operative times compared to LH. LAVH showed favorable perioperative outcomes, including shorter hospital stays and faster recovery, but was less frequently studied in advanced-stage cancers. Complication rates were generally lower in minimally invasive surgeries compared to open procedures. The findings support the efficacy of LH and RH as viable alternatives to open surgery, with specific advantages depending on patient and disease characteristics. Conclusions: Minimally invasive techniques in gynecological cancer surgery offer significant advantages in terms of recovery and complication rates. Despite these benefits, further research is needed to confirm their oncological safety and overall effectiveness compared to traditional open surgeries. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of suturing the cuff to the uterosacral ligaments (USL) during vaginal hysterectomy on healing with regards to anatomy and lower urinary tract symptoms (LUTS). Materials and Methods: This study was carried out on patients, who applied to the Urogynecology Outpatient Clinics of Muğla Research and Training Hospital between the dates of March 2021 and March 2022 and were diagnosed as having uterine prolapse. All of the patients were operated on by the same experienced surgeon (Prof. AAS) and the newly created vaginal cuff was sutured to the USL. In the preoperative period, all patients underwent pelvic organ prolapse quantification (POP-Q) system measurement, and were questioned about LUTS, including stress urinary incontinence, urgency, urge incontinence, frequency, hesitancy, abnormal micturition, nocturia, dysuria, pelvic pain, fecal incontinence, incomplete evacuation of stool, constipation, and vaginal wind. The patients, who were operated on, were reevaluated with respect to POP-Q and LUTS in the follow-up period at the 3rd, 6th and 12th months. Results: A total of 80 patients were included in this study. POP-Q points; Aa, Ba, C, Ap and Bp measurements were significantly deeper and genital hiatus measurements were significantly narrower after surgery than during the preoperative period. No statistically significant difference was observed in the perineal body and with respect to total vaginal length measurements. Moreover, statistically significant improvements were found in the symptoms of urgency, urge incontinence, stress urinary incontinence, frequency, abnormal micturition, nocturia, pelvic pain, fecal incontinence, incomplete evacuation of stool and constipation. In the POP-Q scoring performed in the postoperative follow-up of the cases, the C value was taken as a reference for de novo vaginal vault prolapse. There were 8 cases of recurrence. The mean C value was +3.6 in these cases. Recurrent cases were treated with LeFort colpocleisis, iliococcygeal fixation and posterior intravaginal sling (PIVS) operations. No recurrence was observed in the follow-ups. Conclusion: The suturing of the newly created vaginal cuff during vaginal hysterectomy to the USLs is a very simple, easily applicable, highly effective surgical technique with low morbidity and low risk of vaginal vault prolapse. This technique should be included in the armamentarium of all surgeons dealing with urogynecology due to the positive effect it provides in LUTS as well as anatomical healing. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy for endometrial hyperplasia and endometrial cancer in morbidly obese patients is challenging. Here, we reported data regarding three minimally invasive approaches. Method: This is a multicenter retrospective study evaluating 30-day and 90-day surgery-related outcomes of morbidly obese patients (those with BMI > 40kg/m2) undergoing robotic-assisted, laparoscopic, and vaginal hysterectomy. Results: Charts of 95 morbidly obese patients who underwent surgery for endometrial cancer were retrieved. Overall, robotic-assisted, laparoscopic, and vaginal surgeries were performed in 35 (36.8%), 38 (40%), and 22 (23.2%) patients, respectively. Patients having robotic-assisted surgery experienced longer operative time than patients having vaginal and laparoscopic approaches (p < 0.001). Surgical approaches did not influence the risk of having intraoperative and severe (Clavien-Dindo grade 3 or more) postoperative complications. No 90-day mortality occurred. Conclusions: Robotic-assisted, laparoscopic, and vaginal surgery represent three safe and feasible minimally invasive approaches to manage morbidly obese patients with endometrial hyperplasia and endometrial cancer. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Hysterectomy is a gynecological procedure that can lead to complications arising from structural changes incurred during the surgical process. Vaginal nodules may appear at the vaginal cuff after hysterectomy, which could be indicative of recurring cancer, endometriosis, or formation of fistulae or granulation tissue. In rare instances, abdominal organ prolapse occurs after vaginal cuff dehiscence. Prolapse of the terminal ileum is the most common type of prolapse from vaginal cuff dehiscence, but prolapsed epiploica of colon after hysterectomy occurs in rare instances. Epiploic appendages are a type of fatty tissue attached to the colonic surface that can become inflamed or necrotic and detach from the colon. The purpose of this report is to describe a rare case of prolapsed epiploica of colon at the vaginal cuff. Case Report: A 55-year-old woman who had robot-assisted laparoscopic hysterectomy for endometrioid carcinoma presented with a vaginal polyp 2 months after surgery. Histological analysis of the excised polyp revealed adipose tissue with fat necrosis and calcification, indicative of prolapsed epiploica of colon. This is the first report of posthysterectomy epiploica of colon at the vaginal cuff not associated with obvious dehiscence. Conclusions: This case highlights the importance of thorough histological analysis of excised vaginal nodules and consideration of prolapsed epiploica of colon in the differential diagnoses in addition to benign and malignant vaginal neoplasms. [ABSTRACT FROM AUTHOR]

This is a single Institute, prospective cohort study. We enrolled twenty-two postmenopausal women with pelvic organ prolapse planning to undergo vaginal hysterectomy with transvaginal pelvic reconstructive surgery, with or without a concomitant anti-incontinence procedure. Vaginal swabs and urine samples were longitudinally collected at five time points: preoperative consult visit (T1), day of surgery prior to surgical scrub (T2), immediately postoperative (T3), day of hospital discharge (T4), and at the postoperative exam visit (T5). Women experiencing urinary tract infection symptoms provided a sample set prior to antibiotic administration (T6). Microbiome analysis was performed on vaginal and urinary specimens at each time point. Region V3-V5 of the 16S ribosomal RNA gene was amplified and sequenced. DNA samples were analyzed for visit T1, T2, T5 and T6. Six (27.3%) participants developed postoperative urinary tract infection whose vaginal sample at first clinical visit (T1) revealed beta-diversity analysis with significant differences in microbiome structure and composition. Women diagnosed with a postoperative urinary tract infection had a vaginal microbiome characterized by low abundance of Lactobacillus and high prevalence of Prevotella and Gardnerella species. In our cohort, preoperative vaginal swabs can predict who will develop a urinary tract infection following transvaginal surgery for pelvic organ prolapse. ClinicalTrials.gov Identifier: NCT02751073. [ABSTRACT FROM AUTHOR]

Background: Bilateral oophorectomy has been linked to numerous health outcomes, some of which can have a long latency period. Limited data are available on bilateral oophorectomy prevalence among U.S. women. Methods: The National Health Interview Survey fielded measures of bilateral oophorectomy most recently in 2010 and 2015. We pooled these 2 data years to present bilateral oophorectomy prevalence estimates by age-group, race, ethnicity, geographic region, and hysterectomy status. Results: Our study found bilateral oophorectomy was common among older women. Among women aged 70–79 years, 29% reported a bilateral oophorectomy, compared with <1% for women aged 20–29 years. By geographic region, bilateral oophorectomy prevalence among women 20–84 years was 12.3% in the South, 10.8% in the Midwest, 9.4% in the West, and 8.0% in the Northeast. Small numbers limited our ability to generate age-specific estimates for American Indian and Alaska Native women and subgroups of Asian and Hispanic women. Nearly half of women who had a bilateral oophorectomy reported their procedure occurred more than 20 years ago. Among women aged 20–84 years who reported a hysterectomy, 57% reported they also had both of their ovaries removed. Conclusion: Standard measures of incidence rates for ovarian cancer are not adjusted for oophorectomy status. These findings suggest that ovarian cancer incidence rates may be underestimated among older women. Continued monitoring of bilateral oophorectomy prevalence will be needed to track its potential impact on ovarian cancer incidence and numerous other chronic health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the preferable route of hysterectomy by comparing the intra-operative and postoperative complications of non-descent vaginal hysterectomy with abdominal hysterectomy. Study Design: Randomized Control Trial. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: January 2022 to December 2022. Methods: Forty cases of each vaginal and abdominal hysterectomy were enrolled for study. Outcomes were measured by recording intra-operative and post-operative complications in both groups. Results: Time of surgery, postoperative pain, postoperative blood transfusion, wound infection, febrile morbidity and duration of hospital stay were significantly less (p value 0.0001) in the non-descent vaginal hysterectomy compared to abdominal hysterectomy. Conclusion: Non-descent vaginal hysterectomy is a safe and cost effective approach when compared to abdominal rout due to less intra and post operative morbidity particularly in settings where facilities and expertise for laparoscopic surgery are lacking. [ABSTRACT FROM AUTHOR]

We present two cases of patients with body mass index (BMI) >50 undergoing transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for gynecological indications. Case 1 involves a 52‐year‐old woman with post‐menopausal bleeding and suspicion of ovarian torsion, while case 2 describes a patient with newly diagnosed endometrial adenocarcinoma. Both cases highlight the feasibility and challenges of vNOTES in this patient population. To date, this is the first paper to describe the use of vNOTES in patients of Asian ethnicity, with BMI >50. [ABSTRACT FROM AUTHOR]

Vaginal cuff rupture is a rare but serious postoperative complication predominantly occurring after hysterectomy. Given that it can lead to partial or total evisceration, bowel strangulation, sepsis, and acute mesenteric ischemia. Any instance of this complication should be treated as a surgical emergency. In this context, we report a case of a vaginal stump following regular use of pessaries. Case Report: A 50-year-old woman was admitted to the hospital with sudden onset of bowel-like prolapse from the vagina. She had a 7-year history of vaginal prolapse and had previously undergone repair surgery and laparoscopic hysterectomy for uterine fibroids. Following her hysterectomy, she began using a pessary due to recurrent prolapse. Clinical assessment revealed vaginal evisceration of the intestines, necessitating emergency surgery. She was discharged smoothly on the eighth day post-operation. Three months later, she underwent a laparoscopic sacrocolpopexy. Conclusion: The utilization of pessaries may heighten the risk of stump rupture in patients following hysterectomy, thereby demanding more vigilant attention from gynecologists. [ABSTRACT FROM AUTHOR]

Background and Aims: This network meta‐analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy. Methods: We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk‐of‐bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta‐analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically. Results: A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single‐site surgery‐laparoscopic‐assisted vaginal hysterectomy (LESS‐LAVH) demonstrated superior outcomes in terms of complications, infections, and 24‐h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time. Conclusion: LESS‐LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high‐quality, large‐scale, multicenter RCTs. [ABSTRACT FROM AUTHOR]

Ureaplasma parvum is one of the most common endemic mycoplasmas in the genitourinary tract and can cause amniotic fluid infection leading to preterm labor. We report a rare case of Ureaplasma parvum infection ascending from the vagina to the abdominal cavity after hysterectomy, causing vaginal cuff infection, postoperative peritonitis, and small bowel obstruction. A 29‐year‐old nulliparous woman presented with infected uterine cervical cancer. After radical hysterectomy for uterine cervical cancer, the patient had paralytic ileus with ascites and fever. Peritonitis was suspected; however, all cultures were negative, making it difficult to identify the causative organism. Polymerase chain reaction (PCR) of the ascites revealed Ureaplasma parvum, which could be treated with levofloxacin (LVFX). Open drainage to control the infection revealed a necrotic tissue around vaginal cuff and the small intestine encased in cocoon‐like fibers like sclerosing encapsulating peritonitis. After the infection was improved, the bowel obstruction was also improved. Ureaplasma spp. can be difficult to culture. PCR testing for Ureaplasma infection should be considered when urogenital infection is suspected in patients prone to opportunistic infections, such as those with malignant tumors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hysterectomy (HE) is the most common surgical procedure in gynecology worldwide. The guidelines of most countries unanimously recommend vaginal hysterectomy (VH) as the access of first choice. However, there are significant international differences in the implementation of this recommendation. Methods: In the consistent implementation of the national guidelines, the aim of this prospective observational cohort study was to evaluate how many hysterectomies can be performed vaginally under real-world conditions for benign indications excluding genital prolapse and extensive endometriosis. For this purpose, the requirements of the guidelines were implemented for all HE cases. All HEs were performed by a single, experienced surgeon. The aim was not to go to the limits of the method, but to develop a reproducible benchmark with the lowest possible complication rate. Results: From 2011 to 2020, 230 hysterectomies were performed for benign indications. A VH was performed in 146 cases (63.5%), and a laparoscopic hysterectomy (LH) in 75 cases (32.6%). An abdominal hysterectomy (AH) was only required in nine cases (3.9%). The decision for LH was made in half of the cases due to the assumed presence of endometriosis or a significantly enlarged uterus. The median duration of VH was 32 min (range 16–118 min), and the uterine weights were 15–540 g. The rate of postoperative complications of VH was 3.4%. Conclusions: In line with international guidelines, VH is possible in over 60% of cases with a short surgical time and a low complication rate. LH procedures are useful in the presence of assumed additional pathology in 35%. AH is reserved for huge uteri. A reduction in AH below 10% is possible. The global target could be a rate of 60–30–10% for VH, LH, and AH. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to assess trends in hysterectomy routes by patients who are likely and unlikely candidates for a vaginal approach. Methods: We performed a retrospective cohort study of patients who underwent vaginal, abdominal, or laparoscopic/robotics-assisted laparoscopic hysterectomy between 2017 and 2020 using the National Surgical Quality Improvement Program database. Patients undergoing hysterectomy for a primary diagnosis of benign uterine pathology, dysplasia, abnormal uterine bleeding, or pelvic floor disorders were eligible for inclusion. Patients who were parous, had no history of pelvic or abdominal surgery, and had a uterine weight ≤ 280 g on pathology were considered likely candidates for vaginal hysterectomy based on an algorithm developed to guide the surgical approach. Average annual changes in the proportion of likely vaginal hysterectomy candidates and route of hysterectomy were assessed using logistic regression. Results: Of the 77,829 patients meeting the inclusion criteria, 13,738 (17.6%) were likely vaginal hysterectomy candidates. Among likely vaginal hysterectomy candidates, the rate of vaginal hysterectomy was 34.5%, whereas among unlikely vaginal hysterectomy candidates, it was 14.1%. The overall vaginal hysterectomy rate decreased −1.2%/year (p < 0.01). This decreasing trend was nearly twice as rapid among likely vaginal hysterectomy candidates (−1.9%/year, p <.01) compared with unlikely vaginal hysterectomy candidates (−1.1%/year, P < 0.01); the difference in trends was statistically significant (p < 0.01). Conclusions: The rate of vaginal hysterectomy performed for eligible indications decreased between 2017 and 2020 in a national surgical registry. This negative trend was more pronounced among patients who were likely candidates for vaginal hysterectomy based on favorable parity, surgical history, and uterine weight. [ABSTRACT FROM AUTHOR]

Objective: Uterine-sparing surgery for pelvic organ prolapse (POP) repair has shown good results, but the potential negative implications of leaving the uterus in place are yet to be fully defined. We aimed to assess the risk of unanticipated abnormal gynecological pathology at the time of reconstructive pelvic surgery. Methods: A retrospective consecutive case series including women who underwent vaginal hysterectomy for POP repair at a tertiary medical center in 2006–2020. All patients were offered a free Pap smear test at the age of 65 years as part of a national screening program. Transvaginal ultrasound was routinely performed preoperatively. Standard 3 pedicle hysterectomy was performed with/without bilateral salpingo-oophorectomy (BSO). Results: The study comprised 462 women of mean age 63 ± 9.3 years without previous known malignant or premalignant pathology. Benign pathology was observed in 286 patients (61.9%). Endometrial malignancy was found in three patients (0.7%) and significant premalignant pathology in 15 patients (3.2%), including cervical intraepithelial neoplasia stage 2–3 in seven patients (1.5%) and complex hyperplasia with atypia in eight patients (1.7%). All these pathologies were found in postmenopausal women. None had preoperative clinical symptoms or endometrial thickness of ≥5 mm on preoperative ultrasound. In the 35 patients after BSO, adnexal findings were normal (77.2%) or benign (22.8%). Conclusions: Premenopausal women with uterovaginal prolapse and normal preoperative evaluation have a minimal risk of significant abnormal uterine pathology. In postmenopausal women, the risk of unanticipated malignant uterine pathology is 0.7% and 3.2% for significant premalignancy. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy has been suggested to increase the risk of urinary incontinence (UI), although evidence is controversial. In our population‐based cohort study, we aimed to assess the independent effect of hysterectomy on the risk of de novo UI. Material and Methods: This is a population‐based cohort study on the women of the Northern Finland Birth Cohort 1966 (n = 5889). We identified all hysterectomies among the cohort (n = 461) using the national Care Register for Health Care and classified them according to surgical approach into laparoscopic (n = 247), vaginal (n = 107), and abdominal hysterectomies (n = 107). Women without hysterectomy formed the reference group (n = 3495). All women with UI diagnoses and operations were identified in the register, and women with preoperative UI diagnosis (n = 36) were excluded from the analysis to assess de novo UI. Data on potential confounding factors were collected from registers and the cohort questionnaire. Incidences of different UI subtypes and UI operations were compared between the hysterectomy and the reference groups, and further disaggregated by different hysterectomy approaches. Logistic regression models were used to analyze the association between hysterectomy and UI, with adjustments for several UI‐related covariates. Results: We found no significant difference in the incidence of UI diagnoses or the rate of subsequent UI operations between the hysterectomy and the reference groups (24 [5.6%] vs. 166 [4.7%], p = 0.416 and 14 [3.3%] vs. 87 [2.5%], p = 0.323). Hysterectomy was not significantly associated with the risk of any subtype of UI (overall UI: OR 1.20, 95% CI 0.77–1.86; stress UI (SUI): OR 1.51, 95% CI 0.89–2.55; other UI: OR 0.80, 95% CI 0.36–1.74). After adjusting for preoperative pelvic organ prolapse (POP) diagnoses, the risk was decreased (overall UI: OR 0.54, 95% CI 0.32–0.90; other than SUI: OR 0.40, 95% CI 0.17–0.95). Regarding different hysterectomy approaches, the risks of overall UI and SUI were significantly increased in vaginal, but not in laparoscopic or abdominal hysterectomy. However, adjusting for preoperative POP diagnosis abolished these risks. Conclusions: Hysterectomy is not an independent risk factor for de novo UI. Instead, underlying POP appears to be a significant risk factor for the incidence of UI after hysterectomy. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologist. It can be performed by vaginal, abdominal and laparoscopic route. Vaginal hysterectomy ranks as one of the least and minimally invasive types of hysterectomies, and it has better outcomes and fewer complications when compared to other types. This study assesses the intraoperative and postoperative complications of vaginal hysterectomy. Material & Methods: This hospital based retrospective observational study was carried out from March 2023 to March 2024. A total of 105 patients who underwent vaginal hysterectomy were included in this study. Age, parity, associated medical conditions like anaemia, diabetes, hypertension, thyroid disorders, indications for vaginal hysterectomy, intraoperative complications like excessive blood loss, bladder, bowel or ureteric injuries, conversion to TAH, postoperative complications like vault infection, subacute intestinal obstruction, VVF, RVF, stress urinary incontinence and vault prolapse were analysed. Results: Our study included 105 patients. Majority were in the age between 40 - 49 years (69%). AUB (L)was the commonest indication for vaginal hysterectomy (60%). There was no excessive blood loss for any patient and none needed blood transfusion. Bladder injury occurred in 1 case (0.9%), Subacute intestinal obstruction occurred in 1 case (0.9%), conversion to TAH in 2 cases (1.8%). 2 cases (1.8%) developed vault cellulitis, whereas 3 cases (2.7%) developed stress urinary incontinence. Conclusions: In majority of the cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The postoperative hospital stay was restricted to 4 days in 85.7% of cases which indicates early discharge of the patient. Post-operative complications such as vault cellulitis(1.8%) and stress urinary incontinence(2.7%) were seen only in few cases. So, Vaginal hysterectomy is associated with quicker recovery, early mobilization, shorter hospitalization, less operative and postoperative morbidity. Therefore, vaginal hysterectomy should be considered as the primary route for all hysterectomies unless contraindicated. [ABSTRACT FROM AUTHOR]

Objective: This study examined postoperative urinary retention (POUR) rates in patients who had transvaginal or transabdominal morcellation for large fibroids or adenomyotic uteri. Materials and Methods: This retrospective, observational cohort study was conducted, from January 2015 to April 2021, in a multicenter health care system, in Calgary and Southern Alberta, Canada. The patients were women, ≥18 years, who had total laparoscopic hysterectomy with morcellation. Women with preexisting urinary retention were excluded. POUR was urinary retention needing an indwelling or in-and-out catheter postoperatively before discharge. Results: There were no differences in POUR for transvaginal (29/139; 20.9%) and transabdominal (12/56; 21.4%) morcellation. There were also no differences in time to first postoperative void (5.5 hours [range: 3.5–8] versus 5.75 hours [range: 4–7.125]); length of stay (23 hours [range: 20.875–25.625] versus 22 hours [range:18.5–24.5]); postoperative urinary tract infections (5.1% versus 3.6%); or visits to the emergency department for POUR postdischarge (1.4% versus 1.8%) for transvaginal and transabdominal morcellation, respectively. The vaginal-morcellation group trended toward increased complication rates during morcellation (7% versus 0%) and urinary complaints at postoperative follow-ups (9.4% versus 0%). Conclusions: Either morcellation type produces similar rates of POUR. Surgeon and patient preferences guide decisions on preferred morcellation routes. Larger prospective trials are needed to further assess POUR, potential for increased complications, and postoperative urinary complaints induced by transvaginal morcellation. (J GYNECOL SURG 20XX:000) [ABSTRACT FROM AUTHOR]

Background/Aim: Hysterectomy is the most frequent gynecological surgery. Vaginal hysterectomy (VH) seems to be related to favorable perioperative outcomes compared to abdominal or laparoscopic approaches. As the population ages, anesthesia that is safer for the elderly, such as local anesthesia (LA) with conscious sedation, is gaining popularity and is related to favorable outcomes in patients’ recovery compared to general or regional anesthesia. We aimed to evaluate the efficacy of dexmedetomidine versus propofol for women undergoing VH for uterine prolapse under LA and conscious sedation. Patients and Methods: A prospective study on 40 women with uterine prolapse stage ≥3 who had VH under LA with conscious sedation under either dexmedetomidine (n=20) or propofol (n=20) was performed. A standardized surgical approach with continuous hemodynamic monitoring and sedation assessment using the Ramsay Sedation Scale (RSS) was conducted. The primary endpoint of the study was to determine the percentage of patients receiving intraoperative fentanyl. Results: Analysis of outcomes demonstrated a significant reduction in the proportion of patients requiring intraoperative rescue fentanyl (35% vs. 5%, respectively, p=0.04) and in postoperative pain scores, with more patients achieving an optimal RSS score of 3 in the dexmedetomidine group. Conclusion: Based on the findings of the present study, dexmedetomidine offered superior analgesia and patient comfort compared to propofol, suggesting a favorable anesthetic profile for VH under LA. [ABSTRACT FROM AUTHOR]

Vaginal evisceration is an exceedingly rare and poorly documented complication following vaginal hysterectomy. Prompt detection and surgical intervention are critical to prevent severe complications such as bowel ischemia, perforation, and secondary sepsis. We present the case of an 84-year-old woman with a history of vaginal hysterectomy two years prior, who presented with acute abdominal pain and a significant portion of her small bowel protruding through a defect in the vaginal vault. The patient was urgently transferred to the operating room, where the loops of the small bowel were manually reduced through the vaginal defect. As the bowel appeared viable, no resection was required. The etiology of this condition is unclear and likely multifactorial. Various surgical approaches, including laparoscopic, abdominal, transvaginal, and combined techniques, have been described, all offering comparable outcomes. Therefore, the choice of surgical procedure should be tailored to the patient's clinical presentation. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Colpocleisis is a surgical procedure intended to treat pelvic organ prolapse. Compared with other modes of pelvic reconstructive surgery, colpocleisis is associated with lower morbidity and higher satisfaction, and has a success rate of 91–100% and a reoperation rate of less than 2%. However, there is limited information on how to treat recurrent prolapse after colpocleisis. Methods: We performed a review of the existing literature regarding colpocleisis failure and retreatment. A total of 118 articles were reviewed, with 16 articles suitable for inclusion. We also describe a case from our own institution of a "repeat colpocleisis" for recurrent prolapse after previous colpocleisis. Results: "Repeat colpocleisis" was the most common surgical technique used (18 out of 24 patients, 75.0%). The median follow-up time after the repeat surgery was 12 months, with only 1 patient with recurrence reported owing to recurrent rectocele 2 years after surgery, treated successfully with perineorrhaphy. Other less common techniques included perineorrhaphy, reversal of colpocleisis with native tissue repair, and vaginal hysterectomy with vaginal repair. Our case report describes the surgical management of a patient who had previously undergone LeFort colpocleisis with recurrence of prolapse, subsequently undergoing repeat colpocleisis. Conclusions: The colpocleisis failure, though rare, presents a surgical challenge owing to both its rarity and the paucity of information in the literature regarding the optimal mode of management. In this review, the most common technique for surgical management of colpocleisis failure was repeat colpocleisis, with good short-term success rates noted. Additional studies with longer-term follow-up are needed. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of preoperative anxiety on pain and analgesic consumption in patients undergoing vaginal hysterectomy (VH) with general and spinal anesthesia. Material and methods: A total of 200 participants, including 100 undergoing vaginal hysterectomy with general anesthesia (group 1) and 100 with spinal anesthesia (group 2), were enrolled. A visual analog scale (VAS) was used for the postoperative pain intensity. Results: The 1st hour, 6th hour, 12th hour, and 18th hour VAS scores were higher in vaginal hysterectomy with general anesthesia than in vaginal hysterectomy with spinal anesthesia. Conclusions: Although participants undergoing VH with spinal anesthesia (preoperative state anxiety inventory score > 45) had lower pain intensity scores in the first 18 hours compared to those undergoing VH with general anesthesia, their postoperative analgesic requirements were similar. [ABSTRACT FROM AUTHOR]

Background: Sheehan's syndrome is a rare condition, which is classically characterized by anterior pituitary hypofunction following postpartum shock or hemorrhage. While diabetes insipidus (DI) is not commonly associated with Sheehan's syndrome, we present a rare case of a multiparous female developing rapid-onset panhypopituitarism and DI following severe postpartum hemorrhage. Case presentation: A previously healthy 39-year-old woman, gravida 5, para 4, presented with hypovolemic shock after vaginal delivery, attributed to severe postpartum hemorrhage, necessitating emergent hysterectomy. Although her shock episodes resolved during hospitalization, she developed intermittent fever, later diagnosed as adrenal insufficiency. Administration of hydrocortisone effectively resolved the fever. However, she subsequently developed diabetes insipidus. Diagnosis of Sheehan's syndrome with central diabetes insipidus was confirmed through functional hormonal tests and MRI findings. Treatment consisted of hormone replacement therapy, with persistent panhypopituitarism noted during a ten-year follow-up period. Conclusions: Sheehan's syndrome is a rare complication of postpartum hemorrhage. Central diabetes insipidus should be suspected, although not commonly, while the patient presented polyuria and polydipsia. Besides, the potential necessity for long-term hormonal replacement therapy should be considered. [ABSTRACT FROM AUTHOR]

This case report details the surgical treatment of a rare enlarged cervical leiomyoma with uterine prolapse in a 48-year-old woman. She presented to Konyang University Hospital with a palpable vaginal mass, lower abdominal pain, and urinary incontinence. Despite being nulliparous, she had severe chronic constipation due to schizophrenia medication and lived in a health care facility separated from her family. Pelvic examination revealed stage 3 uterine prolapse with a large necrotic cervical leiomyoma. A robot-assisted vaginal hysterectomy followed by sacrocolpopexy was performed using the Da Vinci Xi Surgical System. Histopathology confirmed cervical leiomyoma with squamous metaplasia. At a three-month follow-up, there were no complications, pelvic anatomy was restored, and urinary incontinence improved. Although the patient had a systemic infection due to the necrotic cervical leiomyoma, raising concerns about the increased risk of infection associated with mesh use, she was high-risk for pelvic organ prolapse (POP) recurrence due to her medical history and living situation. Therefore, she underwent concurrent surgeries with pre- and postoperative antibiotic treatment, and recovered without complications. Given that the risk of developing POP increases after a hysterectomy, in high-risk patients, as demonstrated in this case, the concurrent surgical correction of POP may be an effective strategy. [ABSTRACT FROM AUTHOR]

Background: Delayed spinal epidural hematoma (SEH) following central neuraxial block (CNB) is a rare but serious complication. The underlying causes of SEH associated with neuraxial anesthesia are still unclear. Furthermore, the decision between surgical intervention and conservative management for SEH remains a complex and unresolved issue. Case Presentation: We report a case of delayed SEH in a 73-year-old woman who underwent vaginal hysterectomy under combined spinal-epidural anesthesia, with the administration of postoperative anticoagulants to prevent deep vein thrombosis on the 1st postoperative day (POD). She experienced symptoms 56 h after CNB. Magnetic resonance imaging (MRI) revealed a dorsal SEH at the L1-L4 level with compression of the thecal sac. On conservative treatment, full recovery was achieved after six months. Conclusions: This case reminds anesthesiologists should be alert to the possible occurrence of a delayed SEH following CNB, particularly with the administration of anticoagulants. Immediate neurological evaluation of neurological deficit and MRI are advised. Conservative treatment combined with close and dynamic neurological function monitoring may be feasible for patients with mild or nonprogressive symptoms even spontaneous recovery. [ABSTRACT FROM AUTHOR]

Background: Even though the vaginal route is said to be the gynaecologist route of surgery, abdominal hysterectomy remains the predominant method of uterine removal in most parts of the world, despite the evidence of the safety of vaginal hysterectomy. The study aims to determine the prevalence, sociodemographic variables, indications as well as outcome of vaginal hysterectomy at Federal Teaching Hospital (FTH) Katsina, during the 5-year study period. Methodology: A five-year retrospective study on vaginal hysterectomy was conducted in Federal Teaching Hospital, Katsina from 1st January 2015 to 31st December 2019. Results: The rate of hysterectomies (Abdominal & Vaginal) was 21.6% of the total major gynaecological surgeries performed during the study period. Vaginal hysterectomy accounted for 6.7%. The mean age and parity of the patients were 56.06+/- 9.55 years and 10.17+/- 4.57 respectively. The commonest indication was Utero-vaginal Prolapse (88.9%) and 80.5% (29) of the patients had no complications. Most of the patients (94.4%) were discharged within 7 days of surgery and there was no fatality. Conclusion: The rate of vaginal hysterectomy in our centre is low. Most of the patients were grand multiparous with the main indication being Uterovaginal prolapse. It is associated with favourable outcomes and very low complication rates. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The safety and feasibility of same-day discharge (SDD) has been consistently reported across the benign and gynecologic oncology literature. However, outcomes of SDD in the urogynecology population are sparse. The objectives of this study were to describe the success of SDD following vaginal hysterectomy and native-tissue colpopexy, and to compare the incidence of postoperative adverse events in patients discharged same-day versus postoperative day 1 (POD1). Further objectives were to compare pain, quality of recovery (QoR), and satisfaction between the groups. Methods: This was a single-center, prospective cohort study of patients with planned SDD. A standardized ERAS protocol was utilized. The QoR-40 questionnaire was administered at baseline, POD2, and the 6-week postoperative visit. Pain scores were captured similarly, and a satisfaction survey was administered at 6 weeks. The primary outcome was composite adverse events defined as any postoperative adverse event and/or health care utilization, excluding telephone calls, and urinary tract infection. Results: A total of 101 patients were enrolled in the study; the primary outcome was available for 99. SDD was achieved for 76 patients (77.0%); 23 patients stayed overnight (23.2%). The overall incidence of composite adverse events was 20.2% (95% CI, 13.5–29.2), and was not different between the groups (26.1% vs 18.4%, p = 0.42). Additionally, there were no differences in the QoR-40 or pain scores on POD2 and at 6 weeks. Patient satisfaction was high and similar between the groups. Conclusions: Successful SDD was achieved in 77.0% of the patients. SDD following vaginal hysterectomy and native-tissue colpopexy appears to be safe, feasible, and associated with good QoR and a high degree of patient satisfaction. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable. Methods: Literature review to provide an overview of current evidence and experts' opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use. Results: Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery. Conclusions: Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction and Hypothesis: The aims of this study were to define long-term anatomic outcome, satisfaction rate, and reasons for disappointment and regret in a group of patients with advanced pelvic organ prolapse who underwent LeFort colpocleisis (LFC). Materials and Methods: This was a retrospective, single-center, cohort study including consecutive patients who underwent LFC from 2007 to 2021. All patients had surgery involving vaginal hysterectomy and anti-incontinence procedure where clinically indicated. All patients were examined 3 months after surgery. A cross-sectional telephone survey was performed in 2022 using the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), and Patient Global Impression of Change (PGI-C) questionnaires, as well as the Decision Regret Scale. Student's t -test, Fisher's Chi-square test, and univariable logistic regression analysis were carried out. Results: One hundred and forty-one patients (mean age 74.95 ± 6.25 years) were included. The mean preoperative POP Quantification C/D point was +6 (±2.7). In 86 (60.99%) patients, a hysterectomy and in 56 (39.71%), a mid-urethral synthetic sling was performed. At 3-month follow-up, there was one prolapse recurrence (0.71%) and no case of regret of sexual function loss. In the long term, 28 patients died, and 69 patients were interviewed through telephone (follow-up 61.65 months). The mean PGI-S, PGI-I, and PGI-C scores were 1.42 (±0.81), 1.93 (±1.45), and 5.91 (±1.69) respectively, and no patient declared regret about vaginal intercourse loss. Preoperative and postoperative persistent or de novo mixed UI appeared to be related to decreased satisfaction and regret post-LFC (P = 0.0021). Conclusion: LFC is a valuable, easy-to-perform technique with long-lasting results and decreased postoperative anti-incontinence rates. However, de novo or persistent urinary incontinence appears to be related to decreased satisfaction rates. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to compare the short‐term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. Methods: There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow‐up visits were scheduled at the first week and 1 month after surgery. Results: The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p =.09). Operation time was significantly shorter in the shull group (p <.001), and the hospitalization period (p =.029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p <.001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. Conclusion: vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP‐Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short‐ and long‐term results of vNOTES versus conventional USLS are needed. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic organ prolapse (POP) and overactive bladder (OAB) commonly affect the aging female population. We aimed to investigate the possible relationship between the two, as reflected by urodynamic studies. Methods: A retrospective analysis was conducted on women who underwent urodynamic studies at a university-affiliated tertiary medical center from January 2018 to January 2021. Women presenting with urge incontinence and diagnosed with detrusor overactivity (DO) were included in the study. Based on the presence or absence of a modified POP-Q ≥ grade 2, these women were categorized into two groups. Data on general demographics, clinical symptoms, and urodynamic findings were extracted and compared using SPSS. Results: During the study period, 949 urodynamic evaluations were performed. Of these, 303 (31.92%) reported urge incontinence. Out of this subset, 151 (49.83%) were diagnosed with DO. Within this group, 18 (11.9%) had POP, while 134 (88.1%) did not. The POP group had a notably higher incidence of prior vaginal hysterectomy and anterior colporrhaphy (p = 0.02 and p = 0.01, respectively). While most urodynamic parameters were similar between groups, there was a significant increase in hesitancy in the POP group (13 s vs 8 s, p = 0.03). There was a trend indicating a reduced median Q max (12 ml/s vs. 18 ml/s, p = 0.06) and an increased flow time (55 s vs 40 s, p = 0.08) in the POP group. Conclusion: The urodynamic profile of the POP group suggests an obstructive voiding pattern. Further longitudinal research is essential to fully understand the relationship between POP and OAB. [ABSTRACT FROM AUTHOR]

Comparison of the applicability, safety, and surgical outcomes of total vaginal NOTES hysterectomy (TVNH) using natural orifice transluminal endoscopic surgery, which is considered a natural orifice surgery for hysterectomy with bilateral salpingo-oophorectomy (HBSO) in virgin transgender men, with conventional total laparoscopic hysterectomy (TLH). A retrospective cohort study was conducted between 2019 and 2021. The results of transgender male individuals who underwent HBSO operations using TVNH (n = 21) were compared with those who underwent operations using TLH (n = 62). TVNH was performed in 21 individuals, while TLH was performed in 62 individuals. Patients in the TVNH approach group had a longer operation duration than those in the TLH group (p =.001). Patients in the TVNH group experienced less pain at two hours (5 ± 1.56), six hours (4 ± 1.57), 12 h (2 ± 0.91), and 24 h (1 ± 0.62) postoperatively (p =.001). The postoperative hospitalization duration was shorter in the TVNH group (1.6 ± 1.01) than in the TLH group (2.9 ± 0.5) (p =.001). For the HBSO operation of female-to-male transgender individuals, TVNH, which is completely endoscopically performed, can be preferred and safely conducted as an alternative surgical method to conventional laparoscopy. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean scar ectopic pregnancies (CSEPs) are associated with significant maternal morbidity and termination is often recommended in the early first trimester. Management of more advanced cases is challenging due to higher risks of major intraoperative hemorrhage. Hysterectomy is currently the intervention of choice for advanced cases. This study aimed to investigate if advanced live CSEPs could be managed effectively conservatively using suction curettage and interventional radiology. Material and methods: A retrospective single‐center cohort study was performed. A total of 371 women diagnosed with CSEP were identified between January 2008 and January 2023. A total of 6% (22/371) women had an advanced live CSEP with crown‐rump length (CRL) of ≥40 mm (≥10 weeks' gestation). Of these, 77% (17/22) opted for surgical intervention, whilst the remaining five continued their pregnancies. A preoperative ultrasound was performed in each patient. All women underwent suction curettage under ultrasound guidance and insertion of Shirodkar cervical suture as a primary hemostatic measure combined with uterine artery embolization (UAE) if required. The primary outcome was rate of blood transfusion. Secondary outcomes were estimated intraoperative blood loss, UAE, intensive care unit admission, reintervention, hysterectomy, hospitalization duration and rate of retained products of conception. Descriptive statistics were used to describe these variables. Results: Median CRL of the 17 patients included was 54.1 mm (range: 40.0–85.7) and median gestational age based on CRL was 12 + 3 weeks (range: 10 + 6–15 + 0). On preoperative ultrasound scan placental lacunae were recorded in 76% (13/17) of patients and color Doppler score was ≥3 in 67% (10/15) of patients. At surgery, Shirodkar cervical suture was used in all cases. It was successful in achieving hemostasis by tamponade in 76% (13/17) of patients. In the remaining 24% (4/17) patients tamponade failed to achieve complete hemostasis and UAE was performed to stop persistent arterial bleeding into the uterine cavity. Median intraoperative blood loss was 800 mL (range: 250–2500) and 41% (7/17) women lost >1000 mL. 35% (6/17) needed blood transfusion. No women required hysterectomy. Conclusions: Surgical evacuation with Shirodkar cervical suture and selective UAE is an effective treatment for advanced live CSEPs. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure‐specific simulation skills, vs usual training, result in improved operative competence. Material and methods: We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self‐confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). Clinicaltrials.gov: Registration no. NCT05887570. Results: We randomized 83 residents to intervention or control and 55 completed the trial (2011–23). Baseline characteristics were similar, except for more fourth‐year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2–16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8–22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self‐confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups. Conclusions: Compared to usual training, procedure‐specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Vaginal cuff dehiscence post‐hysterectomy is rare yet significant. Early recognition and prompt surgical intervention are crucial to prevent complications like bowel infarction. Consider second‐look laparotomy in cases of uncertain bowel viability. Vaginal cuff dehiscence (VCD) is a rare but potentially life‐threatening complication following a hysterectomy characterized by the separation of the vaginal vault. This condition, which may result in vaginal evisceration (VE), presents a significant risk of pelvic contents, particularly the small bowel, protruding into the vagina. Early diagnosis and prompt surgical intervention are paramount to prevent severe complications, including bowel infarction, obstruction, and peritonitis. Although VCD and VE are rare, they require urgent surgical management to avoid adverse outcomes. We reported a case of small bowel evisceration in a woman with a history of total abdominal hysterectomy 6 months ago. VCD and VE are very rare but life‐threatening complications of hysterectomy. Discussing the symptoms with patients who have multiple risk factors is crucial to avoid severe sequels following hysterectomy. Based on our experience, performing a second‐look laparotomy is a reliable approach to ensure the viability of the intestinal loop. However, it will likely increase the risk of infection. [ABSTRACT FROM AUTHOR]

Objective: To compare the technique of total laparoscopic hysterectomy (TLH) and laparoscopic assisted vaginal hysterectomy (LAVH) in order to identify the procedure with better outcome. Study Design: Prospective Comparative study. Setting: Northwest General Hospital and Research Center and Lady Reading Hospital, Peshawar. Period: 1st Jan, 2018 till 31st Dec, 2022. Methods: All the patient presenting in out-patient department needing hysterectomy with benign pathologies, perimenopausal age group, size of the uterus =12 weeks and with no previous history of abdominal surgery were placed alternatively in to two groups. Group A included patients who were supposed to undergo Total Laparoscopic Hysterectomy, where uterus was supposed to be delivered vaginally and vault was to be repaired via intracorporeal sutures over uterine manipulator. While group B included patients who were to be operated by Hybrid laparoscopic/vaginal technique and vault was to be repaired vaginally after delivering the uterus vaginally. Data was collected, placed on SPSSR version 16.0 and data was analyzed. Results: 62 patients were included in this study and were placed alternatively in to each group. The demographic values of both groups showed no significant differences for age, BMI and preoperative hemoglobin levels. The higher age group presenting with dysfunctional uterine bleeding was insignificantly more common in Group A whereas fibroids were more common in group B, yet a non-significantly higher age was recorded in group B. Conclusion: Both Laparoscopic assisted Vaginal hysterectomy (LAVH) and Total Laparoscopic hysterectomy (TLH) are feasible options for benign uterine pathology with lesser operative time in hysterectomy performed by the TLH method. The Total laparoscopic Hysterectomy (TLH) results in lower per-operative and post-operative blood loss as compared to the Laparoscopic assisted vaginal technique (LVAH). [ABSTRACT FROM AUTHOR]

Purpose: Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data, however, on same-day discharge outcomes for vaginal hysterectomy and pelvic reconstruction. This study aimed to compare 30 and 90-day surgical outcomes between same-day discharge versus overnight stay following vaginal hysterectomy and apical suspension. Patients and Methods: This retrospective study evaluated surgeries performed over two time periods. Overnight stay was standard between December 2018 and February 2020. Same-day discharge was standard from December 2020 to February 2022. All patients who underwent vaginal hysterectomy with apical suspension were included. The primary outcome was to determine if there was an increase in 30-day readmission rates. Secondary outcomes included emergency department visits and reoperations within 30 days, the previous variables at 90 days, and the rate for successful same-day discharge. Results: A total of 324 patients were analyzed over the 30 months: 149 (46%) in the overnight stay group and 175 (54%) in the same-day discharge group. At 30 days, no difference was found between groups for readmissions (2.7% vs 4.0%, p = 0.56), emergency department visits (14.8% vs 14.9%, p = 1.0), or reoperations (2.0% vs.1.7%, p = 1.0). At 90 days, outcomes were also similar. Same-day discharge as standard practice was successful in 80% of patients. Conclusion: In this retrospective two cohort study, the safety of same-day discharge following vaginal hysterectomy with apical suspension was demonstrated with no increased risk of 30 or 90-day readmissions, emergency visits, or reoperation rates. The majority (80%) of patients were discharged on the day of surgery, suggesting feasibility of this model. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible association of the presence and type/location of placenta previa on MRI with PAS and maternal peripartum outcome. One hundred eighty-nine pregnant women (mean age: 35 years; mean gestational age: 32 weeks) at high risk for PAS underwent a dedicated placental MRI. All women underwent a C-section within 6 weeks from the MRI. All MRIs were evaluated by two experienced genitourinary radiologists for presence, type (complete/partial vs. marginal/low lying), and location (anterior vs. anterior-posterior vs. posterior) of placenta previa. Statistical analysis was performed for possible association of type/location of previa with placental invasiveness and peripartum outcomes. Intraoperative information was used as a reference standard. Complete/partial previa was detected in 143/189 (75.6%) and marginal/low lying previa in 33/189 (17.5%) women; in 88/189 (46.6%) women, the placenta had anterior–posterior, in 54/189 (28.6%) anterior and in 41/189 (21.7%) posterior. Complete/partial previa had an at least 3-fold probability of invasiveness and was more frequently associated with unfavorable peripartum events, including massive intraoperative blood loss or hysterectomy, compared to low-lying/marginal placenta. Posterior placental location was significantly associated with lower rates of PAS and better clinical outcomes. In conclusion, the type and location of placenta previa shown with MRI seems to be associated with severity of complications during delivery and should be carefully studied. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with the neuromuscular structure of the vagina in women without prolapse, to determine the difference, and to demonstrate the role of neuromuscular structure in the physiopathology of prolapse. Materials and Methods: In this prospective study, women aged between 40 and 75 years who had not undergone any vaginal surgery and had not undergone any abdominal prolapse surgery were included. Thirty-one women diagnosed with rectocele on examination were included in the study group. Thirty-one patients who underwent vaginal intervention and hysterectomy for reasons other than rectocele (colposcopy, conization, etc.) without anterior or posterior wall prolapse were included in the control group. Biopsy material was obtained from the epithelium of the posterior wall of the vagina, including the fascia that fits the Ap point. Immunohistochemical staining with Protein Gene Product 9.5 and smooth muscle α-actin was performed in the pathology laboratory. The epithelial thickness measurement and smooth muscle density parameters obtained with these immunohistochemical stainings were compared between the two groups. The collected data were analyzed using the SPSS 23 package program. p values less than 0.05 were considered statistically significant. Results: In the control group, muscle thickness and the number of nerves per mm2 of fascia were statistically significantly higher than in the study group (p < 0.05). Conclusions: We found that smooth muscle tissue and the number of nerves per mm2 of fascia were decreased in posterior vaginal wall prolapse compared to the general population. Based on the correlation coefficients, age was the parameter that most affected the degree of prolapse, followed by parity, number of live births, and number of vaginal deliveries. [ABSTRACT FROM AUTHOR]

Objective: Aim of the study is to compare the efficacy of vessel sealing for securing pedicles in vaginal hysterectomy as compared to total laparoscopic hysterectomy in terms of operating time, perioperative Hb differences, time taken for ambulation, postoperative pain, hospital stay and Intra and Post-op complications. Method: This is a prospective randomized controlled clinical trial conducted at GMERS Medical College and Hospital, Sola, Ahmedabad over a period of about 3 years. A total of 102 patients were divided into 2 groups randomly. One group is operated by Vessel Sealing Device via Vaginally and other group is operated by total laparoscopic hysterectomy. Result: Significant reduction in operative time, post operative pain, pre and post-op Hb deficit, time taken for ambulation and hospital stay in Vaginal Hysterectomy with Vessel Sealer were found compared to Total laparoscopic hysterectomy. There was no significant difference in major intraoperative and post-operative complications. Conclusion: Vaginal Hysterectomy with Vessel Sealer is an effective alternative to Total Laparoscopic Hysterectomy. [ABSTRACT FROM AUTHOR]

Aim and background: Over the past few decades, laparoscopic hysterectomies have dramatically increased and even exceed vaginal hysterectomies (VHs). This study aimed to determine which approach offers the greatest benefits based on the results of a total laparoscopic hysterectomy (TLH) and a laparoscopic-assisted vaginal hysterectomy (LAVH). Materials and methods: We performed a prospective study on patients posted for hysterectomy in the Department of Obstetrics and Gynecology from January 2021 to December 2021. An equal number of patients were posted for TLH and LAVH, according to the selection criteria, randomly, after getting written consent. The average age of the TLH group was 44 years and LAVH group was 46 years. Results: Among 100 patients, 50 patients were included in the LAVH group and 50 were included in the TLH group. A total of 30 patients were presented with previous lower abdominal pelvic surgery such as tubal ligation and appendectomy LSCS. The majority of patients who underwent TLH and LAVH were pathologically confirmed uterine fibroids (n = 36) and adenomyosis (n = 36). The LAVH required longer surgery duration (122.5 ± 25.37) than TLH (114.2 ± 18.93) with p = 0.066. In both groups, the average hospital stay was almost the same (4.26 vs 4) days. Conclusion: Total laparoscopic hysterectomy has an advantage over LAVH in terms of duration of surgery, blood loss, hospital stay, and postepisode recovery. Moreover, the decision to perform either LAVH or TLH should be based on the healthcare expertise in the field of laparoscopic and vaginal operative procedures. Also, patients' satisfaction and mental health is a hallmark of surgeries. Clinical significance: Based on the present study, we recommended that TLH be an effective operative procedure as compared to LAVH. Because it requires a short duration for surgery, there is minimum blood loss, it does not require a prolonged hospital stay, and the patient's recovery time is also effective. [ABSTRACT FROM AUTHOR]

Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage. [ABSTRACT FROM AUTHOR]

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Objective: Placenta accreta spectrum disorder (PAS) is a serious obstetric complication associated with significant maternal morbidity and mortality. Prophylactic balloon occlusion (PBO), as an intravascular interventional therapies, has emerged as a potential management strategy for controlling massive hemorrhage in patients with PAS. However, current evidence about the clinical application of PBO in PAS patients are still controversial. This study aimed to evaluate the effectiveness and safety of PBO in the management of PAS. Methods: A retrospective cohort study including PAS patients underwent cesarean delivery was conducted in a tertiary hospital from January 2015 to March 2022. Included PAS patients were further divided into balloon and control groups by whether PBO was performed. Groups were compared for demographic characteristics, intraoperative and postoperative parameters, maternal and neonatal outcomes, PBO-related complication and follow up outcomes. Additionally, multivariate-logistic regression analysis was performed to determine the definitive associations between PBO and risk of massive hemorrhage and hysterectomy. Results: A total of 285 PAS patients met the inclusion criteria were included, of which 57 PAS patients underwent PBO (PBO group) and 228 women performed cesarean section (CS) without PBO (control group). Irrespective of the differences of baseline characteristics between the two groups, PBO intervention did not reduce the blood loss, hysterectomy rate and postoperative hospital stay, but it prolonged the operation time and increased the cost of hospitalization (All P < 0.05) Additionally, there were no significant differences in postoperative complications, neonatal outcomes, and follow-up outcomes(All P > 0.05). In particular, patients undergoing PBO were more likely to develop the venous thrombosis postoperatively (P = 0.001). However, multivariate logistic regression analysis showed that PBO significantly decreased the risk of massive hemorrhage (OR 0.289, 95%CI:0.109–0.766, P = 0.013). The grade of PAS and MRI with S2 invasion were the significant risk factors affecting massive hemorrhage(OR:6.232 and OR:5.380, P<0.001). Conclusion: PBO has the potential to reduce massive hemorrhage in PAS patients undergoing CS. Obstetricians should, however, be aware of potential complications arising from the PBO. Additionally, MRI with S2 invasion and PAS grade will be useful to identify PAS patients who at high risk and may benefit from PBO. In brief, PBO seem to be a promising alternative for management of PAS, yet well-designed randomized controlled trials are needed to convincingly demonstrate its benefits and triage the necessity of PBO. [ABSTRACT FROM AUTHOR]

Introduction: Medical advancements are expected to lead to a substantial increase in the population of women aged 80 and older by 2050. Consequently, a significant number of individuals undergoing corrective prolapse surgery will fall into the elderly-patient category. The research indicates a notable rise in complications associated with prolapse surgery in patients older than 80, irrespective of frailty and other risk factors. Despite these challenges, the vaginal approach has been identified as the safest surgical method for pelvic organ prolapse (POP) repair in the elderly population. For this reason, we aimed to investigate the efficacy, complication rate, and functional outcomes associated with vaginal hysterectomy and an apical suspension/high uterosacral ligaments suspension as a primary technique for prolapse repair, both within a cohort of elderly patients. Methods: We retrospectively analyzed patients who underwent transvaginal hysterectomy plus an apical suspension procedure for stage ≥ II and symptomatic genital prolapse between January 2006 and December 2013. Anatomical and functional outcomes were evaluated. The Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery. Results: Sixty-five patients were included in the analysis. The median age was 81.3 years. All individuals exhibited an anterior compartment prolapse stage II or higher, and the majority also a central prolapse stage II or higher. Notably, all participants reported symptoms of vaginal bulging. Over half of the population (58.6%) complained of incomplete bladder emptying. The intervention for all participants involved a vaginal hysterectomy with an apical suspension. Sixty-three patients (96.9%) and forty-four patients (67.6%) underwent a simultaneous anterior or posterior repair, respectively. Long-term complications (>30 days from surgery) were observed during follow-up, with a median duration of 23 ± 20 months. Seven (10.7%) anatomical recurrences were recorded, five (7.69%) concerning the anterior compartment, one (1.5%) the central, and three (4.6%) the posterior. Nevertheless, none of them necessitated further surgical intervention due to symptoms. Significant anatomical improvements for the anterior, central, and posterior compartments were noticed, compared to preoperative assessment (p < 0.001 for Aa and Ba, p < 0.001 for Ap and Bp, and p < 0.001 for C). PGI-I values established that 100% of patients were satisfied (PGI-I ≥ 2), with a median score of 1.12. Consequently, objective and subjective cure rates were 89.5% and 100%, respectively. Conclusion: Vaginal hysterectomy combined with apical suspension, particularly high uterosacral ligaments suspension, is a safe and effective primary surgical approach, even in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Our study aims to the compare the duration of post-operative analgesia, times of post-operative opioid consumption, post-operative sedation score, and haemodynamic changes between the groups on using 8mg Dexamethasone and 75 µgm clonidine as an adjuvant to 0.25% Ropivacaine in ultrasound-guided bilateral TAP block in patients undergoing total abdominal hysterectomy. Study design: Prospective, randomized, double blinded study with 56 patients were included and allocated using a -generated randomization code into: Group A (n=28 patients): Received USG guided bilateral TAP block with Injection Ropivacaine (0.5%) 20ml + Dexamethasone (8 mg) 2ml + Normal Saline 18 ml and Group B (n=28 patients) Received USG guided bilateral TAP block with Injection Ropivacaine (0.5%) 20ml + clonidine (75mcgs) 0.5 ml + Normal Saline 19.5 ml. Results: The duration of pain relief was highest (14.3 ± 4.7 hours) in group B patients compared to group A (11.1 ± 5.1 hours). The duration of analgesia provided by 75 mcg clonidine was statistically significant (p<0.001). Post-operative opioid consumption was higher in group A compared to group B which is statistically not significant. (P>0.05). There was also no significant difference in between the study groups for sedation scoring and haemodynamic changes. Conclusion: The addition of dexamethasone 8mg or clonidine 75 mcgs to 0.25% ropivacaine significantly prolongs the duration of analgesia and reduces postoperative opioids requirement, thereby facilitating early recovery and ambulation. On comparing, clonidine appears to be superior adjunct, in terms of pain relief. [ABSTRACT FROM AUTHOR]

Background: Multiple factors influence the outcome following a vaginal cuff closure such as the use of instruments for the intracorporeal suturing, the skill of the surgeon and more importantly the indication for surgery and preexisting factors such as diabetes, obesity and smoking. The objective of this study was to compare intra-operative vaginal cuff closure following total laparoscopic hysterectomy using unidirectional barbed suture or vaginal approach, for benign uterine conditions. Materials & Methods: It was a prospective interventional study conducted at obstetrics and gynecology department of northwest general hospital and Lady Reading Hospital Department of Surgery from 1st January 2018 till 31 December 2022. All patients presenting to Out-patient department with benign pathology and needing laparoscopic surgery were put alternatively in two groups. A total of 84 patients were included in this study 42 in each group. Group A included patients where hysterectomy was performed laparoscopically and uterus was delivered vaginally followed by closure of the vault over the manipulator in continuous fashion with PDS 2/0 or Vicryl V-LockR (Covidien). In Group B the Uterine Manipulator was removed and vaginal closure was performed in two layers bidirectionally using Vicryl 2/0. Data was collected, placed on SPSS version 16. and was analyzed. Results: Eighty four (84) patients were subjected to TLH and were alternately placed in to either Group A or B. The mean age and BMI of patients were similar with no statistical differences. The most frequent indication for Hysterectomy in both groups was Fibroid uterus. Eighteen patients (43.9%) from Group A and 21 patients (51.2%) from group B were post-menopausal. Lower operative times was observed in Group B with a mean difference in operative times of approximately 27 minutes was observed ranged between 39.5 and 118.5 minute. Vaginal cuff hematoma was observed more frequently in group A (4 patients). In contrast only two patients (4.8%) from group B had evidence of small hematomas. Conclusion: There is a non-significant difference with Regards to Mean operating time following Laparoscopic Hysterectomy with lesser time taken for Vaginal Cuff repair vaginally as compared to Laparoscopic repair. There is no difference in outcomes between groups for the choice of material used except that the incidence of Vaginal Dehiscence was higher in patients with Laparoscopic repair (Barbed suture Single Layer Continuous Repair). [ABSTRACT FROM AUTHOR]

Out of the total cases of cervical cancer, brain metastases (BMs) are relatively rare, with an estimated incidence rate of 0.63% (range: 0.1%–2.2%). Additionally, BMs prognosis remains poor, and the average patient survival time following a BM diagnosis is 3 to 5 months. Few studies have addressed the effect of programmed cell death‐1 inhibitors against BMs in cervical cancer, although they are an established option for recurrent/metastatic disease. Hence, we report a case involving a 54‐year‐old post‐surgery patient with cervical cancer with a body mass index of 19.5 kg/m2 and Eastern Collaborative Oncology Group (ECOG) performance status of 3; the disease recurred with BMs 1 year later. Intensity‐modulated radiation therapy concurrent with temozolomide and bevacizumab was initiated, following which zimberelimab immunotherapy combined with anlotinib was administered to extend tumor control. The patient had a progression‐free survival duration of 10 months, the tumor response was assessed as a partial response based on the evaluation criteria for solid tumors (RECIST1.1), and the ECOG status improved to 1 after therapy. These findings suggest that immunotherapy‐based combination therapy following radiotherapy may be a good choice for patients with cervical cancer and BMs. [ABSTRACT FROM AUTHOR]

Purpose: Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data, however, on same-day discharge outcomes for vaginal hysterectomy and pelvic reconstruction. This study aimed to compare 30 and 90-day surgical outcomes between same-day discharge versus overnight stay following vaginal hysterectomy and apical suspension. Patients and Methods: This retrospective study evaluated surgeries performed over two time periods. Overnight stay was standard between December 2018 and February 2020. Same-day discharge was standard from December 2020 to February 2022. All patients who underwent vaginal hysterectomy with apical suspension were included. The primary outcome was to determine if there was an increase in 30-day readmission rates. Secondary outcomes included emergency department visits and reoperations within 30 days, the previous variables at 90 days, and the rate for successful same-day discharge. Results: A total of 324 patients were analyzed over the 30 months: 149 (46%) in the overnight stay group and 175 (54%) in the same-day discharge group. At 30 days, no difference was found between groups for readmissions (2.7% vs 4.0%, p = 0.56), emergency department visits (14.8% vs 14.9%, p = 1.0), or reoperations (2.0% vs.1.7%, p = 1.0). At 90 days, outcomes were also similar. Same-day discharge as standard practice was successful in 80% of patients. Conclusion: In this retrospective two cohort study, the safety of same-day discharge following vaginal hysterectomy with apical suspension was demonstrated with no increased risk of 30 or 90-day readmissions, emergency visits, or reoperation rates. The majority (80%) of patients were discharged on the day of surgery, suggesting feasibility of this model. [ABSTRACT FROM AUTHOR]