Patient satisfaction after laparoscopic total or supracervical hysterectomy.

BACKGROUND/AIMS: To evaluate patient satisfaction after laparoscopic supracervical (LASH) or total hysterectomy (TLH). METHODS: Retrospective study of patient satisfaction after LASH or TLH. RESULTS: We studied 40 cases of LASH and another 40 of TLH. The age of the patients, marital status, education level and employment status between the two groups were comparable. Both LASH and TLH results in improvement of general health and symptoms. However, there was no significant difference in patient satisfaction with surgery, in general health, body and self-images, and sexual satisfaction between the LASH and TLH group. Before surgery, patients in the TLH group experienced more pain with a sexual relationship than those in the LASH group. The difference became non-significant after surgery. There was no difference in urinary or gastrointestinal symptoms after either type of hysterectomy. CONCLUSIONS: Both LASH and TLH result in improvement of general health and symptoms. Body and self-images, sexual function, gastrointestinal and urinary functions after LASH or TLH are comparable.

A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia.

STUDY OBJECTIVE: To evaluate the amount of pain during office hysteroscopy and endometrial biopsy with and without intrauterine anesthesia. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: Academic teaching center. PATIENTS: A total of 82 women underwent outpatient hysteroscopy for evaluation of their uterine cavity. INTERVENTIONS: Randomization to local cervical or combined cervical and intrauterine anesthesia. MEASUREMENTS AND MAIN RESULTS: Amount of pain experienced during the procedure; 10, 30, and 60 minutes after the procedure; and during endometrial biopsy. We used a visual analog scale ranging from 0 to 10 (0: no pain, 10: excruciating pain). Of 82 patients, 4 patients were excluded, 36 patients underwent hysteroscopy using local cervical anesthesia, and 42 others with combined cervical and intrauterine anesthesia. The mean age of the patients in the local group was 37.4 +/- 0.8 years and in the combined group was 38.3 +/- 0.7 years. In both groups, patients experienced significantly more pain during and 10 minutes after the procedure than 30 and 60 minutes after. No significant differences occurred in the pain scores during the hysteroscopy, and 10, 30, and 60 minutes after between the 2 anesthesia groups. The pain score in the local group during endometrial biopsy was significantly higher than during (p <.05), 10 minutes after (p <.001), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure, respectively. In the combined group, compared with the pain score during endometrial biopsy, the scores during the hysteroscopy (p <.05), 10 minutes after (p <.01), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure were also less, respectively. CONCLUSION: Intrauterine anesthesia with medicated saline as a distending medium is ineffective. Endometrial biopsy is associated with more pain than hysteroscopy.