C. Huub van der Vaart

Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy

Abstract Objectives To compare the effects of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy on sexual wellbeing. Design Prospective observational study over six months. Setting 13 teaching and non-teaching hospitals in the Netherlands. Participants 413 women who underwent hysterectomy for benign disease other than symptomatic prolapse of the uterus and endometriosis. Main outcome measures Reported sexual pleasure, sexual activity, and bothersome sexual problems. Results Sexual pleasure significantly improved in all patients, independent of the type of hysterectomy. The prevalence of one or more bothersome sexual problems six months after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy was 43% (38/89), 41% (31/76), and 39% (57/145), respectively (χ2 test, P = 0.88). Conclusion Sexual pleasure improves after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. The persistence and development of bothersome problems during sexual activity were similar for all three techniques.

A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function

Objective  To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro‐colpopexy (with preservation of the uterus) on urogenital function.

Does mode of hysterectomy influence micturition and defecation

Objective. Hysterectomy may affect bladder and bowel function. A retrospective study was performed to compare the prevalence of micturition and defecation symptoms between different modes of hysterectomy.

Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth.

To assess the severity of both stress urinary incontinence (SUI) and overactive bladder (OAB) symptoms during and after the first pregnancy, using a self‐reported health‐related quality‐of‐life questionnaire, and to assess the effect of pregnancy and childbirth on bothersome lower urinary tract symptoms (LUTS) persisting at 1 year after the first childbirth.

Pregnancy-related pelvic girdle pain in the Netherlands

Objective. In this longitudinal cohort study, we assessed the prevalence, associated delivery‐related and psychosocial factors and consequences of self‐reported pelvic girdle pain during and after pregnancy in the Netherlands. Methods. A total of 412 women, expecting their first child, answered questionnaires regarding back and pelvic girdle pain, habits, and biomedical, sociodemographic and psychosocial factors, at 12 and 36 weeks gestation, and 3 and 12 months after delivery. In addition, birth records were obtained. Possible associations were studied using non‐parametric tests. Results. The prevalence of self‐reported pelvic girdle pain was at its peak in late pregnancy (7.3%). One out of 7 women suffering from pelvic girdle pain at 36 weeks gestation, and almost half of the women suffering from pelvic girdle pain 3 months after delivery, continued to report symptoms 1 year after delivery. Women reporting pelvic girdle pain are less mobile than women without pain or women with back pain only, and more frequently have to use a wheelchair or crutches. No association was found between obstetric factors and pelvic girdle pain. Women with pelvic girdle pain report more co‐morbidity and depressive symptoms. Recommendations. Normal obstetric procedures can be followed in women reporting pregnancy‐related pelvic girdle pain. Prognosis is generally good, however, women reporting pelvic girdle pain 3 months after delivery need extra consideration. Attention needs to be given to psychosocial factors, in particular depressive symptoms.

What is the effect of overactive bladder symptoms on woman's quality of life during and after first pregnancy?

To evaluate the effect of overactive bladder symptoms (OAB) on womens quality of life (QoL) during and after the first pregnancy, using self‐reported symptom‐based QoL questionnaires.

Protocol for the value of urodynamics prior to stress incontinence surgery (VUSIS) study: a multicenter randomized controlled trial to assess the cost effectiveness of urodynamics in women with symptoms of stress urinary incontinence in whom surgical treatment is considered.

BackgroundStress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting.The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of urodynamics, in women with symptoms of SUI in whom surgical treatment is considered.Methods/designA multicentre diagnostic cohort study will be performed with an embedded randomized controlled trial among women presenting with symptoms of (predominant) SUI.Urinary incontinence has to be demonstrated on clinical examination and/or voiding diary. Physiotherapy must have failed and surgical treatment needs to be under consideration.Patients will be excluded in case of previous incontinence surgery, in case of pelvic organ prolapse more than 1 centimeter beyond the hymen and/or in case of residual bladder volume of more than 150 milliliter on ultrasound or catheterisation.Patients with discordant findings between the diagnosis based on urodynamic investigation and the diagnosis based on their history, clinical examination and/or micturition diary will be randomized to operative therapy or individually tailored therapy based on all available information.Patients will be followed for two years after treatment by their attending urologist or gynaecologist, in combination with the completion of questionnaires.Six hundred female patients will be recruited for registration from approximately twenty-seven hospitals in the Netherlands. We aspect that one hundred and two women with discordant findings will be randomized.The primary outcome of this study is clinical improvement of incontinence as measured with the validated Dutch version of the Urinary Distress Inventory (UDI). Secondary outcomes of this study include costs, cure of incontinence as measured by voiding diary parameters, complications related to the intervention, re-interventions, and generic quality of life changes.Trial registrationClinical Trials NCT00814749.

Vaginal surgery for uterine descent; which options do we have? A review of the literature

Several vaginal procedures are available for treating uterine descent. Vaginal hysterectomy is usually the surgeon’s first choice. In this literature review, complications, anatomical and symptomatic outcomes, and quality of life after vaginal hysterectomy, sacrospinous hysteropexy, the Manchester procedure, and posterior intravaginal slingplasty are described. All procedures had low complication rates, except posterior intravaginal slingplasty, with a tape erosion rate of 0–21%. Minimal anatomical success rates regarding apical support ranged from 85% and 93% in favor of the Manchester procedure. Data on symptomatic cure and quality of life are scarce. In studies comparing vaginal hysterectomy with sacrospinous hysteropexy or the Manchester procedure, vaginal hysterectomy had higher morbidity. Because no randomized, controlled trials have been performed comparing these surgical techniques, we can not conclude that one of the procedures prevails. However, one can conclude from the literature that vaginal hysterectomy is not the logical first choice.

Effects of Vaginal Prolapse Surgery on Sexuality in Women and Men; Results from a RCT on Repair With and Without Mesh

INTRODUCTION In pelvic organ prolapse (POP) repair, the use of synthetic mesh is not only increasing but also a subject of discussion. The focus shifts from anatomical toward functional outcome, with sexual function being an important parameter. One of the concerns with mesh usage in POP surgery is the possible negative effect on sexual function. AIM To compare and assess sexual function in women and men after primary cystocele repair with or without trocar-guided transobturator mesh. METHODS One hundred twenty-five women with a symptomatic cystocele stage ≥ II were included in this multicenter randomized controlled trial and assessed at baseline and 6-month follow-up. MAIN OUTCOME MEASURES Female sexual function was measured by the Female Sexual Function Index (FSFI) and male sexual function by the Male Sexual Health Questionnaire. A subgroup analysis of women with a participating partner was performed. RESULTS In the mesh group, 54/59 women vs. 53/62 in the anterior colporrhaphy group participated. In men, 29 vs. 30 participated. After surgery, FSFI scores were comparable for both treatment groups. However, within group analysis showed significant improvement on the domains pain (effect size = 0.5), lubrication (effect size = 0.4), and overall satisfaction (effect size = 0.5) in the colporrhaphy group. This improvement was not observed in the mesh group. A subgroup of women with a participating partner reported significantly higher baseline domain scores as compared with other women and did not report a significant improvement of sexual functioning irrespective of treatment allocation. Worsening of baseline sexual function was reported by 43% of women in the mesh group compared with 18% in anterior colporrhaphy group (P = 0.05). Male sexual functioning did not change in either group. CONCLUSIONS Women after an anterior colporrhaphy report a significant and clinically relevant improvement of their sexual functioning, whereas women after a mesh procedure did not.

Bacterial colonisation of collagen-coated polypropylene vaginal mesh: are additional intraoperative sterility procedures useful?

Introduction and hypothesisThe use of vaginally implanted polypropylene meshes in the treatment of prolapse is becoming increasingly popular. We set out to detect how often bacterial colonisation of the mesh occurs and if the intraoperative sterility procedures that are applied matter.MethodsIn 64 consecutive women, bacterial colonisation was compared between two intraoperative sterility procedures. Culture swabs of the core mesh were taken during surgery, and the mesh arms removed at the end of surgery were cultured separately.ResultsSixty-seven implants were cultured. In 56 (83.6%) implants, a positive culture with vaginal bacteria was found with very low bacterial density (<103 colony-forming units). No significant differences in bacterial species, density, clinical infection and erosion (two anterior and one posterior) were found between the two intraoperative sterility methods.ConclusionsColonisation of vaginally implanted mesh occurs frequently but in low bacterial densities, irrespective of the intraoperative sterility procedure used.