Vaginal Hysterectomy for the Prolapsed Uterus

Abstract

Although most gynecologists are comfortable performing vaginal hysterectomy in the patient without significant uterovaginal prolapse, vaginal hysterectomy for the prolapsed uterus poses unique challenges and requires an increased awareness of deviations in pelvic anatomy that may result. This review article discusses the background of vaginal hysterectomy performed for uterovaginal prolapse, the pathophysiology of uterovaginal prolapse, preoperative assessment of the patient with uterovaginal prolapse, surgical technique, ureteral anatomy, techniques to avoid injury to the ureter at the time of vaginal hysterectomy for uterovaginal prolapse, and other relevant considerations.

Standardized terminology of apical structures in the female pelvis based on a structured medical literature review

“…These terms are similar to the regions found in the General Anatomy section of Terminologia Anatomica. 6 1) "Vaginal apex" appeared in 15 Synonyms in the literature included "vaginal vault" in 16 citations from 7 different countries (United States, Serbia, China, Hungary, Belgium, Germany, Austria) from 1975 to 2014, 15,20,22,29,32,35,39,50,51,60,62,63,66,73,81,104 "vaginal dome" in 1 citation from 2004 (Belgium), 29 and "vaginal fundus" in 1 citation from 2005 ajog.org but was excluded from this review as representing surgically altered anatomy. The International Continence Society defines "vaginal apex" to include both vaginal vault and cuff scar after hysterectomy 106 ; thus "vaginal apex" is recommended as being more inclusive.…”

“…3) "Cervico-vaginal junction" was used in 1 citation from the United States in 2010. 51 We propose that this term describe the circumferential junction where the upper vagina These terms are abbreviated (see Appendix 1 for full version). These terms are listed in descending order of the number of publications using the Terminologia.…”

“…citations from 6 countries (United States, Korea, Austria, Czech Republic, France, Germany) from 1975 through 2013. 44,47,51,61,79,103,104 This space is a continuation of the vesicocervical space caudal to the "cervico-vaginal junction" and lies between the bladder [A08. (Figure 3).…”

Complicaciones intraoperatorias de la histerectomía vaginal por causas benignas: Experiencia de seis años, Hospital Clínico de la Universidad de Chile

“…La histerectomía vaginal es segura, amigable para la paciente y económicamente conveniente. Está indicada en la mayoría de las pacientes con enfermedad benigna, principalmente en pacientes que tienen cicatrices abdominales por herniorrafias, obesidad mórbida y patologías cardiopulmonares, entre otras (6).…”

“…Diversos estudios, han demostrado las ventajas de la histerectomía vaginal, sobre la histerectomía abdominal, dentro de las que se destacan ser más segura, económica, de menor morbilidad y mejor tolerancia por parte de las pacientes con alto riesgo quirúrgico o de mayor edad (6,7). Es así como en 2008 el Colegio Americano de Obstetras y Ginecólogos concluyó en un reporte bibliográfico del tema, que la histerectomía vaginal está asociada con mejores resultados y menores complicaciones que la histerectomía abdominal o laparoscópica (4).…”