Pentti Kilkku

Supra Vaginal Uterine Amputation VS. Hysterectomy: Effects on libido and orgasm

Postoperative symptoms of hysterectomy have received relatively little attention. In the present study, the first author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 patients with supravaginal uterine amputation preoperatively and 6 weeks, 6 months and 12 months postoperatively. Participation in the follow-up study was 99.5% (211/212) at one year. This paper deals with the effects of the two operations on libido and the frequency of orgasms. In the statistical analysis, McNemars test of symmetry and the Fisher exact test were used. Weak or absent libido was reported preoperatively by 28.0% of hysterectomy patients and by 26.4% of amputation patients. One year postoperatively the corresponding figures were 35.4% and 31.4%. No statistical changes were observed between the two groups or within either group. In the frequency of orgasms a highly significant (p less than 0.001) reduction from the situation before operation to one year postoperatively was detected after hysterectomy. In the supravaginal amputation group no statistically significant decrease was detected. Preoperatively the two groups were alike; one year postoperatively the difference was almost significant (p less than 0.05). The reductions in orgasms after hysterectomy as compared with supravaginal amputation appears to result from the greater radicality of the former; at hysterectomy, the autonomous innervation of the proximal vagina and cervix is damaged more than in supravaginal amputation, the anatomy of the vagina is altered and scar tissue forms in the vagina. It is probable that these changes and subconscious psychological reactions due to total removal of the uterus explain why supravaginal uterine amputation gives better results than hysterectomy.

Supra Vaginal Uterine Amputation VS. Hysterectomy

Abstract. The author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 supra‐vaginal amputation patients, first preoperatively and then 6 weeks, 6 months and one year postoperatively. At 12 months the follow‐up percentage was 99.5 (211/212). This report concentrates on coital frequency and dyspareunia. In the statistical analysis, McNewars test of symmetry and the Fisher exact test were used.

SUPRAVAGINAL UTERINE AMPUTATION VERSUS HYSTERECTOMY WITH REFERENCE TO SUBJECTIVE BLADDER SYMPTOMS AND INCONTINENCE

Abstract. Studies on postoperative symptoms of hysterectomy have devoted scarcely any attention to malfunctioning micturition and pressure sensation in the bladder region. Postoperative occurrence of incontinence is mentioned in some studies. Preoperatively, 33.3% of abdominal hysterectomy patients and 38.3% of patients with supravaginal uterine amputation complained of pressure sensation in the bladder region; one year after operation the corresponding percentages were 9.6 and 10.3. Prior to the operation, a sensation of residual urine after micturition occurred in 28.6% of hysterectomy patients and 35.5% of supravaginal amputation patients; at 1 year postoperatively these figures were 22.1 and 10.3% respectively. The decrease in the supravaginal amputation group is statistically highly significant. Pre‐operative incontinence occurred in 36.2% of hysterectomy and 47.7% of supravaginal amputation patients. Twelve months postoperatively the values were 28.8 and 22.6% respectively, the decrease in the supravaginal amputation group being again statistically highly significant. Development of log‐linear models for both groups gave interactions “earlier urinary tract infections/sensation of residual urine” and “earlier urinary tract infections/incontinence”. Thus the greater reduction in the symptoms in the supravaginal amputation group appears to result rather from the type of operation than from the differences in the two patient groups.

Peroperative Electrocoagulation of Endocervical Mucosa and Later Carcinoma of the Cervical Stump

Abstract. The incidence of carcinoma of the cervical stump is, according to literature, 0.3—1.9%. During the years 1952–78, 2712 subtotal hysterectomies for benign conditions were performed in the Department of Obstetrics and Gynecology in Turku. During the operation the endocervical mucosa was electrocoagulated before closing the stump. Of these patients, 3 have since developed carcinoma of the cervical stump; thus the incidence in our material is 0.11%. It has been supposed that subtotal hysterectomy might have certain benefits in some cases. If so, and in view of the cancer risk being so low in our material, we feel that subtotal hysterectomy is still an applicable method.

Analysis of Intrapartum Fetal Deaths: Their decline with increasing electronic fetal monitoring

Abstract. Over a 12‐year period, from 1970 to 1981, 30600 babies were born at the Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland. During that period, the use of electronic fetal monitoring increased remarkably, being involved in 9, 12, 33 and 95% of all vaginal deliveries during four consecutive 3‐year periods. The number of intrapartum deaths during the same 12‐year period was 52, giving an overall rate of 1.7 per thousand. When 15 lethally malformed infants are excluded, the rate becomes 1.2 per thousand. In the four consecutive 3‐year periods, the death rates were 1.7, 1.9, 1.0 and 0.3 per thousand. Electronic fetal monitoring was not undertaken in any of the cases leading to fetal death. The main factor leading to fetal death could be considered to be hypoxia in approximately 90% of the deaths of normally formed babies. The most common reasons for hypoxia were placental abruption and cord entanglement, yet in many cases only the decreased placental perfusion could be suggested to have caused the hypoxia. The mean weight of those babies that died intra‐partally decreased significantly, being approximately 1 250 g during the last 3‐year period.

Supra Vaginal uterine amputation with peroperative electrocoagulation of Endocervical Mucosa

Abstract. Discussion on the advantages of abdominal hysterectomy versus supravaginal uterine amputation has concentrated on the incidence of carcinoma in the remaining stump, mortality, and other serious complications. During the period 1952‐78 we have performed 2712 supravaginal amputations with peroperative electrocoagulation of en‐docervical mucosa. The incidence of stump carcinoma was 0.11% in this material. In our prospective studies we have shown that supravaginal amputation has certain advantages over abdominal hysterectomy as regards long‐term morbidity. In this paper we describe the method we are using when performing supravaginal uterine amputation.

Sexual function after conization of the uterine cervix

Abstract Conization is known to be an adequate treatment for cervical dysplasia and CIS. However, there are practically no papers on the long-term morbidity after conization. A prospective interview survey of sexual function was done with 64 patients with conizations, the follow-up period being 1 year. There was found to be a significant decrease in the number of patients with dysmenorrhea and dyspareunia and there was no change in libido, experience of orgasm, coital frequency, or in overall satisfaction of sex life. Thus, in these respects, conization is a suitable conservative method when treating dysplasia and CIS.

PREGNANCY AND DELIVERY AFTER CONIZATION OF THE CERVIX

Abstract. Of 327 patients who had undergone conization of the cervix in 1968‐74 in the Department of Obstetrics and Gynecology, Turku University Central Hospital, 249 replied to a questionnaire. Eighty‐nine of these had had total of 112 pregnancies after conization. Conization had only minimal influence on the pregnancies and none on the deliveries. Over 90 per cent of the newborns delivered were full term and without anomalies. The incidence of spontaneous abortions also did not differ from normal.

Colposcopic, Cytological and Histological Evaluation of the Cervical Stump 3 years after supra vaginal uterine amputation

Abstract. Colposcopic, cytological and histological (endo‐cervical curettage) evaluation of the remaining cervical stump was done 3 years after 99 supravaginal uterine amputations performed for benign condition. Peroperative elec‐trocoagulation of the endocervical mucosa had been done in all the patients and postoperative ectocervical electrocoagu‐lation in 39 (39.4%) cases. No active inflammatory, premalignant or malignant changes were detected at the 3‐year examination of the cervix. Furthermore, normal adenomatous epithelium had been wholly or partly relaced by squamous epithelium in 89% of the cases.

Methods for evaluating the intrauterine location of carcinoma

Abstract. The intrauterine location of endometrial carcinoma was investigated with curettage, hysterography and hysteroscopy in 83 patients. These three methods are complementary. Curettage provides important information about the differentiation of the tumor. Hysterography is suitable especially for elucidating the anatomy of the cervical canal and uterine cavity. Direct examination by hysteroscopy gives a reliable picture when defining the boundary between stages I and II.