Hysterectomy is the surgical removal of the uterus, and it may be total (removal of the body, fundus, and cervix of the uterus) or partial (removal of the uterine body while leaving the cervix intact; also called supracervical, Pic. 1). It is the most commonly performed gynecological surgical procedure, and in the majority of cases, it is performed for benign conditions.
This procedure in particular could be:
Hysterectomy can be performed in different ways:
Hysterectomy may be made due to several reasons. It includes from heavy or irregular menstruation periods, through severe chronic pains as the result of adenomyosis (inner lining of the uterus grows into uterus muscle, Pic. 3) or endometriosis (inner lining of the uterus grows outside and cause pain and bleeding), uterine prolapse (when uterus drops through the cervix and protrudes from the vagina) until uterine fibroids (non-cancerous growths within the muscular walls of the uterus, outside the uterus and within the uterine cavity) and several types of cancer (cervical, uterine, ovarian, fallopian tube cancer).
Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases.
Symptoms may be connected to associated diseases, mostly in case, when hysterectomy is later executed. For hysterectomy, the most common reason is uterine fibroids, benign growths of the uterus. Uterine fibroids may cause excessive size of uterus, pressure or pain, bleeding or even severe anemia. Pelvic relaxation is another condition which may lead until hysterectomy. Mild relaxation may cause first degree prolapse when the cervix is on the halfway down to vagina. A woman experiences a loosening of the support muscles and tissues in the pelvic floor area.
The complications of hysterectomy can be divided into intraoperative and postoperative:
The main intraoperative complications are ureteral laceration, rectal injury, main arteries or vein injury, and eventual bladder laceration (if not opened intentionally).
The main postoperative complications could be hemorrhage, wound infection, urine retention, ureter stricture (narrowing of the ureter), and lymphedema (accumulation of lymph in a certain part of the body, due to damage to lymph vessels).
In addition, the nerve-sparing radical hysterectomy was introduced with the intent to spare autonomic nerves and in particular bladder function but not compromising surgical radicality.
In general, open surgery compared to laparoscopic approach seems to be more prone to have operative complications and stump recurrence. Furthermore, the laparoscopic approach seems to have significant reduction of blood loss and hospital stay.
Possible methods of prevention of a hysterectomy include prevention of conditions that may be ultimately treated by a hysterectomy. Some of these conditions, such as uterine fibroids or adenomyosis, have no known and efficient prevention methods. In the case of uterine cancer, avoiding estrogen excess, e.g. by keeping fit and avoiding obesity or overconsumption of exogenous estrogens, is a possible way of prevention, as certain types of uterine cancer are estrogen-dependent. For cervical cancer, avoiding infection with high-risk types of the HPV (human papillomavirus, a virus causing wart-like growths on the skin and mucosal surfaces) is an effective way of prevention.
Uterus is the main part of female reproductive system and represents the place in the body, where the embryo and fetus develop after the conception. Without the uterus, the eggs from ovaries cannot be fertilized naturally and woman cannot conceive the baby and be pregnant.
Infertility is an inevitable result of hysterectomy, with surrogacy and adoption being the only options left for having children. Therefore, hysterectomy is usually performed only in life-threatening conditions, in women who have already completed their reproduction, or in conditions where the uterus is already incapable of a successful pregnancy.
The time in most women's lives when menstrual periods stop permanently, and the woman is no longer able to have children.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
A sperm selection method prior ICSI based on hyaluronic acid binding.
Sperm preparation technique for ART eliminating apoptotic sperms depending on their surface antigens in magnetic field.
The embryo is gestated in a third party's (surrogate) uterus.