Vaginal Hysterectomy - Has it had its day?
IUGA Academy. O'Sullivan O. 06/30/18; 212983; 433
Orfhlaith E O'Sullivan
Orfhlaith E O'Sullivan

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Vaginal Hysterectomy - Has it had its day?

O'Sullivan, OE1; O'Reilly, BA2

1: Cork University Maternity Hospital; 2: Cork University Hospital Cork

Introduction: Vaginal hysterectomy has traditionally been the management of choice for uterine descent. Recently fellowships have become more specialized with regard to surgical approaches. In the literature there has been a shift towards uterine preservation. Surgical training and proficiency affect the management options available for uterine prolapse.

Aim: The aim of this study was to assess Urogynaecologists surgical training and proficiency with regard to various surgical techniques for uterine prolapse. To assess factors which influence decisions for type of surgery, management of complications, techniques used and training provided.

Method: An electronic questionnaire was sent to all European Urogynaecology Association (EUGA) and International Urogynaecology Association (IUGA) members by email or via the e-zine respectively. It constituted 33 questions, which were divided into four categories. The categories included demographics, training, surgical proficiency and selection and technique.

Results: A total of 471 responded. 70% (328) identified as Urogynaecologists, of note 58% dedicate more than fifty percent of their working week exclusively to urogynaecology. 251 (53%) had done a fellowship with the majority (86%) in urogynaecology and pelvic floor reconstruction. 63% highlighted a preference for uterine removal in the presence of uterine descent. The main factors for influencing the decisions were patient preference, patient age and prolapse score. 94% are proficient in performing vaginal hysterectomy and repair; there was a broad range in terms of proficiency and numbers performed per year for other surgical procedures. Specifically in terms of vaginal hysterectomy two thirds of respondents perform 30 of less procedures per year, with 45% quoting a reduction in the number compared to 5-10 years ago.372 felt that 10-30 cases were required to become proficient and a similar number was required to maintain competency. 336/471 felt that trainees should be competent in performing vaginal hysterectomy prior to completing general training in O&G.

Conclusion: Vaginal hysterectomy stills form the cornerstone for the management of vault prolapse. The decision process is influenced by multiple factors including surgical training. Consideration needs to be given to training and maintaining proficiency once achieved


Work supported by industry: no.

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