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Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study
Aubert Agostini1, Florence Bretelle, Ludovic Cravello
1Department of Obstetrics and Gynecology, La Conception University Hospital, Marseille, France.
Objective:
To compare vaginal hysterectomy success and complication rates in nulliparous and primiparous or multiparous women.
Design:
A comparative prospective study.
Setting:
Department of Gynaecology, La Conception Hospital, Marseille, France.
Population:
Three hundred and forty-five consecutive patients without genital prolapse requiring hysterectomy for benign conditions and without previous pelvic surgery or caesareans were treated prospectively by vaginal hysterectomy. Fifty-two patients were nulliparous and 293 were primiparous or multiparous.
Methods:
Data of patients were collected prospectively.
Main Outcome Measures:
Operative time, length of hospital stay, oophorectomy, conversion to laparotomy, intra- and post-operative complications.
Results:
The mean operative time was significantly longer in nulliparous patients [95 (55.2) vs 79.9 (34.9) minutes, P < 0.01]. The overall complication rate was significantly higher [7/52 (13.46%) vs 13/293 (4.44%), P = 0.02, RR = 3.03 (1.27-7.23)] as was the haemorrhage rate in nulliparous compared with the primiparous and multiparous women [4/52 (7.69%) vs 5/293 (1.7%), P = 0.03, RR = 4.51 (1.25-16.23)]. Vaginal hysterectomy was successfully performed in 96.2% (50/52) of the nulliparous and 99.7% (292/293) of the parous patients [P = 0.06, RR = 1.04 (0.98-1.09)].
Conclusion:
The success rate of vaginal hysterectomy in nulliparous women is high. However, the risk of complications seems higher than in the parous women. Laparoscopy assisted vaginal hysterectomy in nulliparous women needs further investigations.