Clinical Study Of Long Term Effect Of Abdominal Total And Extensive Hysterectomy On Pelvic Floor Function

BackgroundTotal hysterectomy is the most common gynecological surgical procedure performed for gynecologic diseases,either benign or malignant diseases.About 90%patients were performed total hysterectomy due to benign disease.Extensive hysterectomy is usually implied to treat early cervical cancer.The most common extensive hysterctomy is Piver ? hysterectomy,which removes more parametrial and paravaginal tissues.Hysterectomy,especially the extensive hysterectomy,may damage pelvic tissues,nerves and ligaments,which could result in pelvic floor dysfunction,presenting as urinary incontinence,fecal incontinence and pelvic organ prolapse,and exert detrimental effect on post-operative living quality of patients.Moreover,with the transformation of medical mode from traditional pattern to bio-psycho-social mode and the improvement of living standards,matters resulted from hysterectomy have been taken more and more seriously.It is of great necessity to study the long term effect of hysterectomy on pelvic floor function.PurposeTo evaluate the Long term effect of abdominal total and extensive hysterectomy on pelvic floor function.Methods171 subjects were enrolled in this retrospective cohort study,who were divided into three groups.Group A covers 58 women having undergone total hysterectomy at Qilu Hospital from January 2011 to December 2012.Group B includes 53 patients having been performed extensive hysterectomy at the same hospital and during the same period.Group C incorporates 60 women without any surgical intervention undergoing physical examination at medical examination center of Qilu hospital.By asking whether they experienced involuntary urine loss over the previous three months to determine whether there is urinary incontinence.By investigating Urogenital Distress Inventory short form(UDI-6),a kind of symptomatic questionnaire,to evaluate the degree of urinary incontinence.By asking whether they experienced involuntary stool loss over the previous three months associated with physical activity to determine whether there is fecal incontinence.By investigating Wexner score of fecal incontinence to evaluate the degree of fecal incontinence.By detecting pelvic organ prolapse quantification to diagnose whether there is pelvic organ prolapse and the degree.Pelvic Floor Impact Questionnaire short form(PFIQ-7),a kind of living quality questionnaire,was used to evaluate the effect of pelvic floor dysfunction on quality of life.Results1.Clinical characteristics of three groups;No significant difference was observed among the above 3 groups in terms of age,parity or body mass index(P<0.05).No significant difference was observed between group A and group B as regard to post-operative interval(P=0.278).2.Results for urinary incontinence:2.1 Morbidity of urinary incontinence:There were 37(69.8%)patients suffered from urinary incontinence in group A and 28(48.3%)and 15(25.0%)in group B and group C respectively.The rates of urinary incontinence were significantly different among three groups(X2=22.776,P<0.001).When comparing inter groups,we found that the morbidity of urinary incontinence of group B was significantly higher than that of group A(X2=5.293,P=0.021).The morbidity of urinary incontinence of group A was significantly higher than that of group C(X2=6.898,P=0.009).2.2 Severity of urinary incontinence:Urogenital Distress Inventory(UDI-6)was used to evaluate the severity of urinary incontinenc.The UDI-6 score was 3.077±3.44,5.86±5.02 and 0.95±1.86 for group A and group B and group C respectively.Significant differences were found among these three groups as regard to UDI-6 score(X2=34.975,P<0.001).When comparing inter groups,we found that UDI-6 score for group B was significantly higher than that for group A(X2=9.159,P=0.002).The UDI-6 score for groupA was significantly higher than that for group C(X=11.602,P=0.001).According to questions of UDI-6,UDI-6 questions could be divided into three parts,which are irrigative symptoms,stress symptoms and obstructive symptoms respectively,significant differences were all found among these three groups whatever any kind of symptom(P<0.05).3.Results for fecal incontinence:3.1 Morbidity of fecal incontinence:There were 4(6.9%)patients affiliated with fecal incontinence in group A and 7(13.2%)and 2(3.3%)in group B and group C respectively.No significant difference was found among these three groups(X2=3.968,P=0.137).3.2 Severity of fecal incontinence:we used fecal incontinence Wexner score to assess the severity of fecal incontinence.Although score for group B(1.32± 2.03)was higher than group A(1.03 ± 2.04)and group C(0.93±1.84),no significant difference was found among these three groups(X2=2.491,P=0.298).4.Results for pelvic organ prolapse:There were 7(12.1%)patients suffered from pelvic organ prolapse in group A,including 4 staged ? and 2 staged ? and 1 staged ?.There were 10(18.8%)patients suffered from pelvic organ prolapse in group B,including 2 staged ?,4 staged ?,3 staged ? and 1 staged ?.4(6.7%)patients were diagnosed with pelvic organ prolapse in group C,including 3 staged ? and 1 staged ?without no patients staged ? or ?.No statistical significance was found among these.three groups as regard to the morbidity of pelvic organ prolapse(X2=3.893,P=0.143).And no significant difference was found among these three groups regarding as the degree of pelvic organ prolapse(X2=5.356,P=0.499).5.Influence of PFD on quality of life:PFIQ-7 was used for assessing the effect of PFD on quality of life.The PFIQ-7 score was 5.01±7.21,7.43±7.29 and 2.81±5.51 for group A and group B and group C respectively.Significant differences were found among these three groups as regard to PFIQ-7 score(X2=18.624,P<0.001).When comparing between groups,we found that score of group B was significantly higher than that of group A(P=0.028),and the latter was significantly higher than that of group C(P=0.022).PFIQ-7 can be divided into three parts,urinary incontinence impact questionnaire(IIQ-7),colorectal-anal impact questionnaire(CARIQ-7)and pelvic organ prolapse impact questionnaire(POPIQ-7),which reflect the effect of ball bladder,rectum,and pelvic organ prolapse on quality of life respectively.Significant difference was found among these three groups as regard to score of IIQ-7,while no obvious differences were found regard as scores of CARIQ-7 and POPIQ-7.Conclusions1.The long term effect of hysterectomy on pelvic floor is mainly urinary incontinence,while fecal incontinence and pelvic organ prolapsed are not significantly affected.2.Comparing with total hysterectomy,extensive hysterectomy may exert more serious effect on patients' post-operative pelvic floor function.