1 / 7

Uterovaginal Prolapse: Hysteropexy vs. Hysterectomy Introduction

Uterovaginal Prolapse: Hysteropexy vs. Hysterectomy Introduction. Marie Fidela R. Paraiso, M.D. Head, Division of Urogynecology Professor of Surgery Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, OH.

fritz-wells
Download Presentation

Uterovaginal Prolapse: Hysteropexy vs. Hysterectomy Introduction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Uterovaginal Prolapse: Hysteropexy vs. HysterectomyIntroduction Marie Fidela R. Paraiso, M.D. Head, Division of Urogynecology Professor of Surgery Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, OH

  2. Concurrent hysterectomy potentially adds to the morbidity, both in the short and long term Increased OR time Increased bleeding Increased complexity Evidence to implicate concurrent hysterectomy as a risk factor for subsequent mesh erosion [1,2,3] Culligan PJ et al. Am J Obstet Gynecol (2002) 187: 1473-80; discussion 81-2. Wu JM, et al. (2006) Am J Obstet Gynecol 194: 1418-22. Brizzolara S, et al.(2003) Obstet Gynecol 102: 306-10. Whether or not to remove the normal uterus during POP surgery is controversial.

  3. CARE TrialAncillary study on Risk Factors for Mesh Erosion Demographic variables Current smoking 5/20 (25%) erosion 18/302 (6%) no erosion OR = 5.2 (CI 1.7,16.0) No other differences Surgical variables Concurrent hysterectomy 12/20 (60%) erosion 71/302 (24%) no erosion OR = 4.9 (CI 1.9,12.4) No differences in: Culdoplasty Mesh configuration Cundiff GW, et al. Am J Obstet Gynecol. 2008 Dec;199(6):688.e1-5. Epub 2008 Oct 31.

  4. Uterine preservation potentially compromises the efficacy of the repair Future uterine pathology may necessitate future surgery Uterine bleeding Difficult hysterectomy Whether or not to remove the normal uterus during POP surgery is controversial.

  5. Comparison of Abdominal sacral hysteropexy to abdominal sacral colpopexy with hysterectomy: A Pilot Study. Cvach K, et al.. International Continence Society Annual Scientific Meeting, Toronto, Canada, August 24, 2010.

  6. Debate Specifics • Affirmative Team: • Dr. Jerry Blaivas • Negative Team: • Dr. Mickey Karram • Moderator: • Dr. Marie Paraiso • Judges: • Captive Audience • Style: Parliamentary (Modified)

  7. Resolution " In counseling a 42 y/o woman with stage III prolapse that includes loss of support of the uterus and associated symptoms of protrusion, but no other uterine pathology, the discussion of surgical management should include concurrent hysterectomy"

More Related