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Thread: Hysterectomy - Removal of the uterus

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    Hysterectomy - Removal of the uterus

    Hysterectomy means the removal of the uterus (womb). A hysterectomy may or may not be combined with the removal of the Fallopian tubes and one or both ovaries. Removal of a tube and ovary is called salpingo-oophorectomy, removal of both tubes and ovaries is called bi-lateral salpingo-oophorectomies (BSO for short).
    There are different types of hysterectomy, which are described according to which organs are removed.

    A total hysterectomy is the most common operation and this means removal of the uterus and cervix (neck of the womb).

    A sub-total hysterectomy means the removal of the body of the uterus, leaving the cervix behind.

    A radical hysterectomy involves the removal of the uterus, cervix, a small portion of the upper part of the vagina and some soft tissue from within the pelvis. A radical hysterectomy is only performed in cases of cancer of the cervix by gynaecologists who have received special training.
    Hysterectomy may be suggested If You Have:

    Uterine Fibroids (myomas)
    These are non-cancerous tumours of different sizes that usually shrink after menopause. Fibroids are common and normally don't need treatment unless they cause symptoms. However, larger fibroids can press against the pelvic organs and may cause bleeding, pain during sex, anaemia, pelvic pain, or bladder pressure. This is the most frequent reason for a hysterectomy.
    When the tissue lining the uterus grows outside of the uterus and onto surrounding organs, it can cause painful periods, abnormal vaginal bleeding, scarring, adhesions, and infertility (difficulty getting pregnant). It is the second most common reason for women to have a hysterectomy.
    Uterine prolapse
    The uterus moves down into the vagina because the tissues that hold the uterus in place weaken. The condition may lead to urinary incontinence (problems holding your urine), pelvic pressure or difficulty with bowel movements. Childbirth, obesity, persistent cough or straining, and hormonal changes (loss of estrogen after menopause) are typical causes.
    Pelvic Pain

    There are many causes and symptoms (ex: painful periods and intercourse) of pelvic pain, and not all can be successfully treated with a hysterectomy. That is why it is important to carefully diagnose the problem and try other treatments first. Endometriosis, fibroids, adhesions, infections or injury may be a few causes of pelvic pain.
    Types of Hysterectomies

    As mentioned before, a hysterectomy is an operation to remove the uterus. Sometimes, other organs that surround the uterus are also removed to properly treat your condition. These organs include the cervix, the fallopian tubes and the ovaries. Your medical history and the reason for the operation will shape the doctor's decision as to which type of hysterectomy is best for you:

    A complete or total hysterectomy removes the uterus, including the cervix. The name is confusing because it does not remove "everything". In fact, the ovaries and fallopian tubes remain. This is the most common type of hysterectomy.

    A partial or subtotal hysterectomy only removes the upper part of the uterus and leaves the cervix and other organs in place.

    A radical hysterectomy removes the uterus, the cervix, the upper part of the vagina, supporting tissues and usually the pelvic lymph nodes. This operation is usually performed to treat cancer.

    In addition to the hysterectomy, you may need to have one or both ovaries removed. This is called a salpingo-oophorectomy. It involves removing the fallopian tube and ovary on one side (unilateral) or both sides (bilateral) of the uterus. This is done mostly in cases of cancer, infection or adhesions. In general, the ovaries and fallopian tubes are left in place unless something is wrong with them.

    How is a hysterectomy performed?

    Hysterectomy is a major surgical procedure and is performed under general anaesthesia.

    In addition to the different types of hysterectomy, there are different ways by which a gynaecologist might perform the operation. This will be influenced by the reason for performing the hysterectomy in the first place, the size of the uterus and the experience and preference of the individual gynaecologist.

    Abdominal hysterectomy is the most common method and is performed through an approximately six inch scar made across the lower abdomen.

    A vaginal hysterectomy is performed through the vagina and will leave no visible external signs that the woman has had an operation.

    In a laparoscopically assisted vaginal hysterectomy (LAVH) the gynaecologist uses keyhole surgery in combination with surgery through the vagina in order to complete the operation

    Vertical and Pfannenstiel incisions

    A vertical incision (left) gives the surgeon greater access to your pelvis. A Pfannenstiel incision (right) follows your skin's natural lines, usually leaving a thinner scar.


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    Last edited by trimurtulu; 01-16-2009 at 09:51 PM.

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