Persistence of Symptoms After Total vs Supracervical Hysterectomy in Women with Histopathological Diagnosis of Adenomyosis
| Autor: | Xiangmei Gu, Emily R. Goggins, Elsemieke A.I.M. Meurs, Jon I. Einarsson, Allison F. Vitonis, Luiz Gustavo Oliveira Brito, Sarah L. Cohen, K.C. Wang, Mobolaji O. Ajao, Mary Cox |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Cervix Uteri Hysterectomy 03 medical and health sciences 0302 clinical medicine Patient satisfaction Surveys and Questionnaires medicine Humans Adenomyosis Laparoscopy Cervix Retrospective Studies 030219 obstetrics & reproductive medicine medicine.diagnostic_test Obstetrics business.industry Obstetrics and Gynecology Retrospective cohort study Odds ratio Middle Aged medicine.disease Confidence interval medicine.anatomical_structure Treatment Outcome Patient Satisfaction 030220 oncology & carcinogenesis Female Symptom Assessment business Boston |
| Zdroj: | Journal of minimally invasive gynecology. 26(5) |
| ISSN: | 1553-4669 |
| Popis: | Study Objective To compare symptom persistence in women with adenomyosis based on retention or removal of the cervix at the time of hysterectomy. Design Retrospective cohort study and follow-up survey (Canadian Task Force classification xx). Setting Tertiary care academic hospital in Boston, Massachusetts. Patients Women (n = 1580) who underwent laparoscopic hysterectomy for benign indications between 2008 and 2012 at Brigham and Women's Faulkner Hospital and Brigham and Women's Hospital. Intervention Retrospective chart review and follow-up survey. Measurements and Main Results Among the 1580 women contacted, 762 (48%) responded to the postoperative symptom resolution survey. Of these 762 women, 623 agreed to participate in the study. Menopausal women or those who had undergone bilateral salpingo-oophorectomy were excluded. Adenomyosis was identified on histopathologic evaluation of the uterus in 171 of the remaining 443 women (39%). Compared with women without adenomyosis, those with adenomyosis were older on average (mean age, 46.6 ± 6.8 years vs 45.0 ± 5.5 years; p = .009) and more likely to report that abnormal bleeding and pain led to their hysterectomy (87.7% vs 79.8%; p = .03 and 64.9% vs 51.4%; p = .009, respectively). The rates of total and supracervical hysterectomies were similar in the 2 groups. Following surgery, women with adenomyosis were less likely than those without adenomyosis to report persistent pain (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.20–0.93; p = .03). Persistent bleeding was similar in the 2 groups (aOR, 0.97; 95% CI, 0.49–1.93; p = .94). Among women with adenomyosis, multivariable logistic regression showed no difference in persistence of symptoms with cervical removal or retention at the time of hysterectomy. Conclusion Compared with women without adenomyosis, those with histopathologically proven adenomyosis were less likely to report persistent pain following hysterectomy. Retention of the cervix does not appear to increase the risk of symptom persistence or postprocedure patient satisfaction. |
| Databáze: | OpenAIRE |
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