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Previous Volume 347:1318-1325 October 24, 2002 Number 17 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Schaffer, J. I. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background It is uncertain whether subtotal abdominal hysterectomy results in better bladder, bowel, or sexual function than total abdominal hysterectomy.

Methods We conducted a randomized, double-blind trial comparing total and subtotal abdominal hysterectomy in 279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. The main outcomes were measures of bladder, bowel, and sexual function at 12 months. We also evaluated postoperative complications.

Results The rates of urinary frequency (urination more than seven times during the day) were 33 percent in the subtotal-hysterectomy group and 31 percent in the total-hysterectomy group before surgery, and they fell to 24 percent and 20 percent, respectively, at 12 months (P=0.03 for the change over time within each group; P=0.84 for the interaction between the treatment assignment and time). The reduction in nocturia and stress incontinence and the improvement in bladder capacity were similar in the two groups. The frequency of bowel symptoms (as indicated by reported constipation and use of laxatives) and measures of sexual function (including the frequency of intercourse and orgasm and the rating of the sexual relationship with a partner) did not change significantly in either group after surgery. The women in the subtotal-hysterectomy group had a shorter hospital stay (5.2 days, vs. 6.0 in the total-hysterectomy group; P=0.04) and a lower rate of fever (6 percent vs. 19 percent, P<0.001). After subtotal abdominal hysterectomy, 7 percent of women had cyclical bleeding and 2 percent had cervical prolapse.

Conclusions Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.

Source Information

From the Department of Gynecology, St. George's Hospital, London (R.T., S.S., I.M.); the Department of Psychology, St. George's Hospital Medical School, London (S.A.); and the Department of Obstetrics and Gynecology, Mayday University Hospital, Croydon, United Kingdom (P.C.).

Address reprint requests to Dr. Manyonda at the Department of Obstetrics and Gynecology, St. George's Hospital, Blackshaw Rd., London SW17 0QT, United Kingdom, or at imanyond{at}sghms.ac.uk.

Full Text of this Article

Related Letters:

Outcomes after Total versus Subtotal Abdominal Hysterectomy
Maas C. P., Kenter G. G., Trimbos B., Severyn K. M., Manyonda I., Thakar R., Ayers S.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:856-857, Feb 27, 2003. Correspondence

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• Schover, L. R. (2005). Sexuality and Fertility after Cancer. ASH Education Book 2005: 523-527 [Abstract] [Full Text]  
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• (2002). Does Hysterectomy Impair Bowel, Bladder, and Sexual Function?. JWatch Women's Health 2002: 5-5 [Full Text]  
• Schaffer, J. I., Word, A. (2002). Hysterectomy -- Still a Useful Operation. NEJM 347: 1360-1362 [Full Text]