A total hysterectomy is also called a simple hysterectomy. A radical hysterectomy removes the uterus, cervix, the uppermost part of the vagina next to the cervix and the nearby ligaments that support the uterus. Nearby lymph nodes in the pelvis are often removed at the same time as part of the staging operation. Sometimes one or both of the ovaries and fallopian tubes are removed at the same time as a hysterectomy.
The removal of the ovaries and fallopian tubes is called a salpingo-oophorectomy. A bilateral salpingo-oophorectomy BSO removes both ovaries and fallopian tubes. A unilateral salpingo-oophorectomy removes one ovary and one fallopian tube. A salpingo-oophorectomy is used to treat ovarian and fallopian tube cancers and is part of a staging operation for uterine cancers. A hysterectomy is most often done in the hospital using a general anesthetic you will be unconscious or a spinal or epidural anesthetic you will be awake but not able to feel the surgery.
You will stay in the hospital for a few days after any type of hysterectomy. Your doctor may prescribe pain medicine and antibiotics to prevent infection. A laparoscopic hysterectomy is done by laparoscopy.
Laparoscopic surgery uses a thin, tube-like instrument with a light and lens called a laparoscope. It allows the surgeon to see the organs to be removed. The laparoscope and surgical tools to remove tissue are passed through small incisions in the abdomen. The uterus is commonly removed through the vagina. Robotic surgery can also be used to remove the uterus. It is also done by laparoscopy, but the surgeon sits at a station a short distance away from the operating table and uses a computer to move robotic arms that are connected to surgical instruments.
A vaginal hysterectomy is done through small incisions in the upper part of the vagina. The uterus is removed through the vagina. A vaginal hysterectomy may be used to treat early stage cancers of the cervix and uterus. Urinary retention — Urinary retention, or the inability to pass urine, can occur after vaginal hysterectomy.
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Urine can be drained using a catheter until retention resolves, usually within 24 to 48 hours. Blood clots — Pelvic surgery increases the risk of developing blood clots in the large veins of the leg or lung.
The risk is increased for approximately six weeks after surgery. Medications may be given to some women to prevent blood clots. In addition, women taking oral contraceptives or hormone replacement should ideally discontinue them one month prior to surgery since they can further increase the risk of blood clots.
Women who are sexually active and premenopausal should use alternative methods of birth control e. Damage to adjacent organs — The urinary bladder, ureters small tubes leading from the kidneys to the bladder , and large and small intestines are located in the lower abdomen and pelvis and can be injured during hysterectomy. Bladder injury occurs one to two percent of women who have vaginal hysterectomy, while bowel injury occurs in less than one percent of women.
Patient Basics: Hysterectomy
Injury can usually be detected and corrected at the time of surgery. If detected after surgery, another operation may be needed. Early menopause — Women who have undergone hysterectomy may experience menopause earlier than the average age of menopause age This may be due to an interruption in blood flow to the ovaries as a result of removing the uterus.
Intravenous IV fluids may be administered during the first day, particularly if there is nausea or vomiting. Pain medicine is given as needed, either intravenously, or by intramuscular IM injection or pill. Patients are encouraged to resume their normal daily activities as soon as possible. Being active is particularly important since it helps to prevent complications, such as blood clots, pneumonia, and gas pains.
More information about recovery from hysterectomy is available separately. Most reported improvement in symptoms directly related to the uterus, including pain and vaginal bleeding. Sexual function and enjoyment, interest in sex, and pain with sex were improved for most women.
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However, this improvement may be dependent upon several factors, including the age of a woman at the time of surgery, the reason for surgery, and history of any prior difficulties with mood. Younger women may grieve after hysterectomy due to their loss of fertility. A woman who has new feelings of sadness, anxiety, or depression after surgery should speak with her healthcare provider. These feelings may be treated by talking with a therapist, with antidepressant medication, or may resolve with time.
Medical and surgical alternatives to hysterectomy depend upon the underlying disorder.
Why it's done
Some alternatives to vaginal hysterectomy include the following: Uterine artery embolization and myomectomy may be used to treat symptomatic leiomyoma fibroids. Pain clinics may be able to treat patients with severe and chronic pelvic pain without surgery. Endometrial ablation, in which a physician destroys or removes most of the endometrium using an instrument inserted through the vagina and cervix and into the uterus. Medical therapy using hormonal medications, such GnRH analogs for example, leuprolide or progestins can help reduce the pain associated with endometriosis.
Cone biopsy eg, cold knife cone , cryosurgery, laser surgery, or loop electrocautery eg, LEEP or LLETZ are usually used to treat women with high-grade cervical intraepithelial neoplasia or carcinoma in situ of the cervix. The following organizations also provide reliable health information.
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