Different Hysterectomies Yield Similar Outcomes


CHICAGO — Ten years after surgery, lower urinary tract symptoms, sexual function, incidence of prolapse, and quality of life did not differ between women randomized to total abdominal hysterectomy versus abdominal supracervical hysterectomy, according to a follow-up study of 54 participants in the Total or Supracervical Hysterectomy (TOSH) trial.

“No significant difference was found in any lower urinary tract or pelvic floor symptom, breast or menopausal symptoms, weight change, or need for treatment of urinary incontinence between the two groups,” reported Dr. Jerod Greer of the University of Alabama at Birmingham at the annual meeting of the American Urogynecologic Society.

“There appear to be no clinically important long-term differences in outcomes that would favor one method of hysterectomy over the other,” he added in a later interview. “However, an important minority of patients undergoing supracervical hysterectomy (SCH) experience continued vaginal bleeding and are at risk for needing future surgical procedures on the retained cervix, an essential point to discuss when counseling patients about hysterectomy.”

The original TOSH trial, published in 2003, followed patients for 2 years and found no differences between the two groups in pelvic floor symptoms (Obstet. Gynecol. 2003;102:453-62). “At the time of the original TOSH trial, some people felt that total abdominal hysterectomy [TAH] was associated with higher rates of sexual dysfunction, lower urinary tract symptoms, pelvic organ prolapse, and surgical complications when compared with abdominal supracervical hysterectomy,” Dr. Greer said. “This was found not to be the case after following patients randomized to TAH versus SCH for 2 years of follow-up. As there were no long-term data on this subject, we thought it would be interesting to see if any differences in the two groups had emerged 9 years after their surgeries.”

Thirty-seven of 54 TOSH participants (69%) returned questionnaires regarding quality of life, sexual function, and pelvic symptoms—the same questionnaires they had completed at the 2-year follow-up.

Of the respondents, 19 had received TAH and 18 had received SCH. Researchers reviewed patients' medical records in addition to analyzing the questionnaires. The two groups did not differ in baseline demographics.

There was a significant improvement within the TAH group in the ability to have and enjoy sex and a significant reduction in vaginal bleeding from baseline to the 9-year follow-up in both groups, Dr. Greer reported.

“Based on our results, there still appears to be no good evidence to favor SCH over TAH, as there were no between-group differences in sexual function scores, lower urinary tract or prolapse symptoms, or quality of life,” he said. “The TAH group showed an improvement in one aspect of sexual function and reported less back pain at 9 years, while two participants in the SCH group had experienced bleeding from the cervical stump and another underwent trachelectomy for persistent cervical dysplasia.”

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