304 Obstetrics and Gynecology Board Review •••
❍ What percentage of hysterectomies are performed via each route?
Abdominal 66%, vaginal 22%, and 12% laparoscopic.
❍ What is the safest and most cost-effective route of hysterectomy?
Vaginal hysterectomy, if feasible.
❍ What are advantages of vaginal hysterectomy versus abdominal hysterectomy?
Shorter duration of hospital stay, faster return to normal activities, fewer febrile episodes, or infections.
❍ What are advantages of vaginal hysterectomy versus laparoscopic hysterectomy?
Shorter operating time.
❍ What is the mortality associated with hysterectomy?
12 deaths per 10,000 procedures—for all surgical indications.
❍ What are alternatives to hysterectomy?
Medical: NSAIDs, antifibrinolytics, hormonal, GnRH agonists, aromatase inhibitors, and Mirena IUD.
Surgical: D & C, endometrial ablation, UAE, myomectomy, MRI-guided focused US treatment.
❍ When is hysterectomy indicated in the management of abnormal uterine bleeding (AUB)?
Hysterectomy may be indicated for women with AUB who have completed their childbearing, particularly if the
bleeding is severe and/or recurrent, and unresponsive to hormonal therapy and endometrial curettage.
❍ Compare outcomes between endometrial ablation, endometrial resection, and hysterectomy in the treatment
of AUB.
Pinion et al. found that hysteroscopic ablation had fewer complications and a shorter postoperative recovery, but
overall satisfaction was higher with hysterectomy.
❍ When is hysterectomy indicated for adenomyosis?
Symptomatic patients who do not experience relief with D & C and hormonal therapy, and who have completed
their childbearing, can be offered hysterectomy.
❍ What are nonsurgical options for uterine prolapse?
Pessary.
❍ When is hysterectomy indicated in treating uterine prolapse?
When the symptoms are, especially in the patient’s view, severe enough to justify the risks of surgery. Hysterectomy
does not necessarily need to be done as part of an operation to correct stress incontinence. A retropubic
urethropexy may be done with the uterus left in place.
❍ What is the relationship of the ureter to cervix with uterine prolapse?
The cervix descends farther than the ureter by a 3:1 ratio. For every 3 cm the cervix descends, the ureter drops
1 cm and the gap between the ureter and the cervix widens by 2 cm.