Patient-Reported Health Outcomes and Quality of Life after Peripartum Hysterectomy for Placenta Accreta Spectrum.

OBJECTIVE: Short-term morbidity of placenta accreta spectrum (PAS) is well described, but few data are available regarding long-term outcomes and quality of life. We aimed to evaluate patient-reported outcomes after hysterectomy for PAS. STUDY DESIGN: This is a prospective cohort study of women with risk factors for PAS who were enrolled antenatally. Exposed women were defined as those who underwent cesarean hysterectomy due to PAS. Unexposed women were those with three or more prior cesareans or placenta previa, but no PAS, who underwent cesarean delivery without hysterectomy. Two surveys were sent to patients at 6, 12, 24, and 36 months postpartum: (1) a general health questionnaire and (2) the SF-36, a validated quality of life survey. Aggregate scores for each questionnaire were calculated and responses were analyzed. RESULTS: At 6 months postpartum, women with PAS were more likely to report rehospitalization (odds ratio [OR] 5.83, 95% confidence interval [CI] 1.40-24.3), painful intercourse (OR 2.50, 95% CI 1.04-6.02), and anxiety/worry (OR 3.77, 95% CI 1.43-9.93), but were not statistically more likely to report additional surgeries (OR 3.39, 95% CI 0.99-11.7) or grief and depression (OR 2.45, 95% CI 0.87-6.95). At 12 months, women with PAS were more likely to report painful intercourse, grief/depression, and anxiety/worry. At 36 months, women with PAS were more likely to report grief/depression, anxiety/worry, and additional surgeries. Women with PAS reported significantly lower quality of life in physical functioning, role functioning, social functioning, and pain at 6 months postpartum, but not in other quality of life domains. Decreased quality of life was also reported at 12 and 36 months in the PAS group. CONCLUSION: Women with PAS are more likely to report ongoing long-term health issues and decreased quality of life for up to 3 years following surgery than those undergoing cesarean for other indications. KEY POINTS: · Long-term placenta accreta spectrum data to guide peripartum patient education.. · This study addresses a critical knowledge gap.. · Women affected by PAS report long-term morbidity..

The Life Quality and Sexual Function of Women Underwent Radical Hysterectomy.

BACKGROUND: Up to date, there no studies were conducted on the quality of life (QL) and sexual function (SF) of women from Kazakhstan treated for cervical cancer. The study was aimed at the assessment of the QL and SF of women of the Kazakh population who underwent radical hysterectomy compared with chemo-radiotherapy group. METHODS: The study was conducted prospectively on 157 women of the Kazakh population. 92 women underwent radical hysterectomy (RH) and 65 underwent chemo-radiotherapy (CRT). The information was collected before treatment (T1), 6 months (T2) and 12 months (T3) after treatment. RESULTS: The women's average age was 41.12 ± 5.4 in the RH group and 47.24 ± 6.1 in the CRT group (p = 0.2). We did not detect significant differences between both groups according to the QLQ C-30 questionnaire (T1). The differences between the RH and CRT groups (p≤0,05) were observed in terms of physical functioning, fatigue, nausea and vomiting, pain during the T2 period. High rates of emotional functioning (p = 0.03), global health and QL (p = 0.02), and symptoms of fatigue (p = 0.04) were detected in the RH group compared to the CRT group during T3. However, pain symptoms (p = 0.001), nausea and vomiting and loss of appetite (p = 0.03) were dominated the CRT group. According to the results of FSFI-6 in the RH group, indicators for the domains "desire" (p = 0.02), "excitement" (p = 0.03), and "orgasm" (p = 0.05) were high, unlike in the CRT group during the T3 period. Nevertheless, the number of complains on the 'pain during intercourse' in the CRT group was higher than in the RH group (p = 0.001). CONCLUSION: Women who underwent RH had better health scores, global health status, and SF compared with patients treated with CRT.

Patient Preferences and Knowledge Regarding Hysterectomy: A Study from the Fellows' Pelvic Research Network (FPRN)®.

OBJECTIVE: The purpose of this study was to describe preference for and knowledge of hysterectomy routes in women presenting to urogynecology/gynecology clinics throughout the United States and to determine association with health literacy. Our primary aim was preference for hysterectomy route, and secondary aims were knowledge of basic pelvic structures and function, knowledge of various hysterectomy routes, and baseline health literacy level. METHODS: This multicenter, cross-sectional study was conducted through the Fellows' Pelvic Research Network. Patients' preference and knowledge for hysterectomy routes were assessed at initial presentation to the urogynecology/gynecology clinic with an anonymous, voluntary, self-administered questionnaire along with a validated health literacy test (Medical Term Recognition Test). RESULTS: Two hundred four women participated. Forty-five percent of patients were unsure which hysterectomy modality they would choose. Of patients who selected a preferred modality, 50% selected laparoscopic and 33% selected vaginal. Patients indicated that safety was considered highest priority when selecting route. The mean score for "knowledge about gynecology/hysterectomy" was 68%, with the high literacy group scoring higher compared with the low health literacy group (70% vs 60.1%, P = 0.01). More than 50% of patients incorrectly answered knowledge questions related to vaginal hysterectomy. Majority of the respondents had high health literacy (79.4%). CONCLUSIONS: Patients prefer laparoscopic hysterectomy approach, although have limited understanding of vaginal hysterectomy. Higher health literacy levels are associated with increased knowledge of gynecology and hysterectomy routes, but were not found to influence patient preference for hysterectomy route. Overall, patients have limited knowledge of vaginal hysterectomy.

Comparison of the Effects of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy on Sexual Function and Quality of Life.

It is known that benign gynecological diseases negatively affect sexual function. For this reason, hysterectomy provides improvement in sexual function as well as symptoms such as bleeding and pain. The effects of abdominal hysterectomy (TAH) and laparoscopic hysterectomy (TLH), which are the two most common types of hysterectomy today, are not clear. In our study, we investigated the effects of TAH and TLH on sexual function and quality of life as well as intraoperative and postoperative results. In 329 TLH and 126 TAH patients, we compared both and between themselves preoperatively and postoperatively by using the standardized and validated female sexual function index (FSFI) and European quality of life five-dimension scale (EQ-5D). In conclusion, we found that both types of hysterectomy were effective in improving sexual function, and we concluded that improvement in the laparoscopy group was statistically higher. Patients who require hysterectomy for benign gynecological reasons should be informed that TLH has a more positive effect on sexual function as well as other advantages, and if the patients' main complaint is sexual dysfunction, TLH should be preferred compared to TAH.

Evaluation of quality of life, body image and surgical outcomes of robotic total laparoscopic hysterectomy and sentinel lymph node mapping in low-risk endometrial cancer patients - A Robotic Gyne Club study.

INTRODUCTION: The aims of the study were to evaluate quality of life, cosmetic results and surgical outcomes of robotic single-site and robotic multiport total laparoscopic hysterectomy with sentinel lymph node mapping in women treated for low-risk endometrial cancer. MATERIAL AND METHODS: The study is a prospective, multicenter, case-control study conducted at Ospedale Santa Chiara in Trento and Novara and Pavia University Hospitals. Seventy-six consecutive patients with a biopsy-confirmed diagnosis of low-risk endometrial cancer or atypical endometrial hyperplasia who between January 2017 and January 2019 had undergone robotic total laparoscopic hysterectomy and sentinel lymph node mapping were included. Data on surgical outcomes, quality of life and cosmetic results were prospectively collected and analyzed based on the surgical approach with robotic single-site vs robotic multiport assistance. Patients' clinical characteristics, intra-operative parameters, sentinel lymph node mapping results and postoperative findings were prospectively recorded. Clinical follow up was performed 4 weeks and 6 and 12 months after surgery. Fifty-one patients underwent a robotic multiport procedure and 25 patients a robotic single-site surgery. RESULTS: There was one significant difference between the two groups in terms of patient characteristics: mean body mass index (BMI) in the multiport group was 29 kg/m2 vs 24.8 kg/m2 in the single-site group (P value <.001). After univariate and multivariate analysis on intraoperative and postoperative findings, a shorter surgical time was observed in the single-site cohort than in the multiport group (148.7 vs 158.2 minutes, P value .0182). BMI also had a significant effect on surgical time (P = .022). No differences were seen in terms of sentinel lymph node detection: the bilateral detection rate was 96.1% for multiport (66.7% bilateral, 29.4% monolateral) and 96% for single-site (76% bilateral, 20% monolateral) procedures. No differences between the two approaches were identified with regard to postoperative complications, pain, cosmetic results or quality of life comparisons. CONCLUSIONS: For the treatment of low-risk endometrial cancer and atypical endometrial hyperplasia with total hysterectomy and sentinel lymph node mapping, the robotic single-port approach is comparable to the multiport procedure in terms of intraoperative and postoperative findings, and has an advantage in terms of shorter surgical times. Further studies are required to identify possible differences in quality of life and cosmetic results.

Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors.

OBJECTIVES: Research about sexual function after hysterectomy is inconclusive. Possible predictive factors for sexual (dys)function are yet to be identified. The aim of this study is to assess the effect of hysterectomy on sexual function in women 3 and 12 months after hysterectomy for benign indications. Furthermore hypothesized predictive factors will be evaluated. STUDY DESIGN: A prospective multicentre cohort study with follow-up at 3 and 12 months after hysterectomy was performed. To assess sexual function a short-form FSFI was used, a score ≤ 19 means sexual dysfunction). Linear mixed model repeated measure analysis was used to assess changes in sexual function in women who were sexually active at all three measure points (N = 260). Linear mixed model analyses were also used for the predictor analyses. RESULTS: The FSFI score increased from 20.94 at baseline to 23.81 at 12 months post hysterectomy. The number of women experiencing sexual dysfunction was 86 (33.1 %). Women without preoperative sexual dysfunction had a significantly higher FSFI score 4.5 (95 % CI 3.5-5.6) one year after the operation than women indicating sexual dysfunction before surgery. Women who were living alone had a significantly higher FSFI score of 2.31 (0.7-4.0) when compared to women who were married or living together. CONCLUSION: FSFI score increases significantly after hysterectomy, which indicates a better sexual function after the operation. Sexual dysfunction before hysterectomy (FSFI score ≤ 19) and being married or living together are predictive factors for a lower FSFI score post hysterectomy.

Factors associated with decision-making on prophylactic hysterectomy and attitudes towards gynecological surveillance among women with Lynch syndrome (LS): a descriptive study.

To prevent endometrial carcinoma in Lynch syndrome (LS), regular gynecological surveillance visits and prophylactic surgery are recommended. Previous data have shown that prophylactic hysterectomy is an effective means of cancer prevention, while the advantages and disadvantages of surveillance are somewhat unclear. We aimed to evaluate female LS carriers' attitudes towards regular gynecological surveillance and factors influencing their decision-making on prophylactic surgery that have not been well documented. Pain experienced during endometrial biopsies was also evaluated. Postal questionnaires were sent to LS carriers undergoing regular gynecological surveillance. Questionnaires were sent to 112 women with LS, of whom 76 responded (68%). Forty-two (55%) had undergone prophylactic hysterectomy by the time of the study. The majority of responders (64/76; 84.2%) considered surveillance appointments beneficial. Pain level during endometrial biopsy was not associated with the decision to undergo prophylactic surgery. The level of satisfaction the women had with the information and advice provided during surveillance was significantly associated with the history of prophylactic hysterectomy (satisfaction rate of 73.2% versus 31.8% of nonoperated women, p = 0.003). The women who had undergone prophylactic surgery were older than the nonoperated women both at mutation testing (median of 42.3 years versus 31.6 years, p < 0.001) and at the time of the study (median of 56.9 years versus 46.0 years, respectively, p < 0.001). Women with LS pathogenic variants have positive experiences with gynecological surveillance visits, and their perception of the quality of the information and advice obtained plays an important role in their decision-making concerning prophylactic surgery.

The Association Between Mindfulness and Postoperative Pain: A Prospective Cohort Study of Gynecologic Oncology Patients Undergoing Minimally Invasive Hysterectomy.

STUDY OBJECTIVE: To describe the association between preoperative dispositional mindfulness (the personality trait of being mindful) and postoperative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy. DESIGN: Prospective cohort study. SETTING: University-affiliated teaching hospital. PATIENTS: Gynecologic oncology patients (n = 126) planning minimally invasive hysterectomy. INTERVENTIONS: Minimally invasive hysterectomy. MEASUREMENTS AND MAIN RESULTS: Baseline mindfulness was assessed at the preoperative visit using the Five Facet Mindfulness Questionnaire (FFMQ). Postoperative pain and opioid usage were evaluated via chart review and surveys at postoperative visits at 1 to 2 weeks and 4 to 6 weeks. Higher baseline mindfulness was correlated with lower postoperative pain as measured by both the average and highest numeric pain scores during the inpatient stay (r = -.23, p = .020; r = -.21, p = .034). At the initial postoperative visit, pain score was also inversely correlated with preoperative mindfulness score (r = -.26, p = .008). This relationship was not observed at the final postoperative visit (r = -.08, p = .406). Pre-operative mindfulness and opioid usage were also inversely associated, though this relationship did not reach statistical significance (r = -.18, p = .066). CONCLUSION: Mindfulness was previously shown to be a promising intervention for chronic pain treatment. Our study demonstrates that higher preoperative dispositional mindfulness is associated with more favorable postoperative pain outcomes, including lower pain scores but not lower opioid consumption. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to reduce postoperative pain in patients following gynecologic surgery.

Effect of psychological care given to the women who underwent hysterectomy before and after the surgery on depressive symptoms, anxiety and the body image levels.

This study was conducted for the purpose of evaluating the effect of the psychological care given to women before and after hysterectomy surgery on depression levels, anxiety and body image. This experimental study was conducted in the gynecological oncology surgery clinic of Samsun Education and Research Hospital in Turkey between the dates of January 2018 and June 2018. Those who meet the sample selection criterion and agreed to participation to the study among the women who were admitted to the clinic for hysterectomy were assigned randomly to the experimental and control groups. 42 women in total including 21 women in each of experimental and control groups formed the sample of the study. The effect of the psychological care was evaluated through Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Body Catherix Scale (BCS). The evaluation measurements were conducted as pre-test, post-test and follow-up (2-months post-test). The BDI and STAI scores of the women who receive psychological care have decreased and their BPS scores have increased. On the contrary, BDI and STAI scores of the women who receive psychological care in the experimental group have increased and their BCS scores have decreased. These findings show that psychological care has positive effects on depressive symptoms, anxiety and the body image in the women who underwent hysterectomy.IMPACT STATEMENTWhat is already known on this subject? Having a hysterectomy impacts a woman's life in a significant manner. As such, deciding to undergo a hysterectomy is a difficult process for women, especially from a psychological perspective. Following a hysterectomy, women commonly experience changes in body perception, such as perceiving the body as different, feeling disabled, feeling hollow, believing they are different than other women and feeling that their body is attracting notice. The literature reports that women perceive themselves as different, alienated, impaired and changed after a hysterectomy and that they have difficulty making contact with the environment; furthermore, the more changes in body perception increase, the more depression increases.What the results of this study add? This study revealed that psychological care given to women before and after undergoing a hysterectomy decreases anxiety and increases positive body perception. For this reason, psychological care for women undergoing hysterectomies should be part of routine nursing care and should be started upon the hospitalisation of the patient.What are the implications of these findings for clinical practice and/or further research? The findings of this study indicate that after a hysterectomy, women experience not only physiological disease symptoms but also psychological problems. Therefore, women who have undergone or will undergo a hysterectomy also have psychological needs. Further study is suggested to determine what can be done with a professional team to meet the demands for psychological care.

Evaluating the Prevalence of Regret With the Decision to Proceed With a Hysterectomy in Women Younger than Age 35.

OBJECTIVE: This study sought to evaluate prevalence of regret with the decision to undergo a hysterectomy at a young age. METHODS: A retrospective cohort study was performed at two centres and included patients who underwent an elective hysterectomy for benign indications under age 35, between January 1, 2008 and December 31, 2015. Eligible patients were contacted and completed a validated decision regret survey and patient health questionnaire. RESULTS: A total of 189 patients met the study criteria. Of the 95 patients who could be contacted, 71 consented to participate (response rate, 75%). The most common indications for surgery were menorrhagia (35.2%), uterine fibroids (22.5%), endometriosis (19.7%), and pain (15.5%). Overall, 91.5% of patients agreed that having this surgery was the right decision for them, and 90% said that they would make the same choice in the future. A total of 2.8% regretted the choice that they made, and 14% responded that this caused them harm. Over 95% of patients reported that the decision was either mostly patient driven or shared with the physician. CONCLUSION: This is the first evaluation of regret after hysterectomy specifically examining a younger patient population. The study results suggest that patients who are appropriately counselled do not regret their decision to proceed with hysterectomy.

Unindicated hysterectomies in India: the aftermath.

Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.

From decision to incision: Ideologies of gender in surgical cancer care.

In this paper, I draw on the narratives of 57 individuals whose gender identities and decisions about their bodies trouble the medical protocols for breast and gynecological cancer care. I focus here on the decision-making process for three groups of elective surgeries: hysterectomy, prophylactic bilateral and contralateral mastectomy, and breast reconstruction. These elective surgeries illustrate places in medical interactions where patients and providers rely on frames of gender to determine whether a given surgery is an appropriate option for cancer prevention or care. These cases also explain how patient experiences of medical interactions are shaped by and thus reproduce ideologies of gender through the bodies of patients. While clinical practice and medical decisions are supposedly determined through the principles of evidence-based medicine and patient-centered care, I show that ideas about gender can actually supersede both medical evidence and patient desires for their bodies in the care of gynecological and breast cancers.

Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India.

BACKGROUND: Evidence of hysterectomy in India is limited mainly due to lack of information in large-scale nationally representative health surveys. In 2015-16, the fourth National Family Health Survey (NFHS-4) - a cross-sectional survey - collected for the first time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. This paper examines the prevalence and determinants of hysterectomy in India among women aged 30-49 years in 29 states and seven union territories (UTs) of India using the NFHS-4 dataset. METHODS: Percentage weighted by sampling weights was used for estimating the prevalence of hysterectomy. The paper used crosstabulations and percentage distributions to estimate the prevalence of hysterectomy across different socioeconomic backgrounds and reasons for undergoing hysterectomy respectively. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. RESULTS: In India as a whole, 6 % of women aged 30-49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs (from a minimum of 2% in Lakshadweep to a maximum of 16% in Andhra Pradesh). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector except in the northeast region. Years of schooling, caste, religion, geographic region, place of residence, wealth quintiles, age, parity, age at first cohabitation, marital status, and body mass index of women were found to be the sociodemographic determinants statistically associated with hysterectomy in India. The reasons reported frequently for hysterectomy were excessive menstrual bleeding/pain (56%), followed by fibroids/cysts (20%). CONCLUSION: The percentage and likelihood of undergoing hysterectomy are relatively high among women from older age groups (45-49), those who reside in rural areas, those without schooling, those who are obese, those having high parity, those with a low age at first marriage, and those who reside in the eastern and southern parts of India. The policy implication of these findings is that the reproductive health program managers should ensure regular screening and timely treatment of the problems resulting in hysterectomy.

Quality of life in patients who undergo conventional or robotic-assisted total laparoscopic hysterectomy: Protocol for a systematic review of randomized controlled trials.

BACKGROUND: Hysterectomy for benign gynecologic diseases, especially dysfunctional uterine bleeding, is one of the most common gynecologic interventions. The uterus can be removed using abdominal, vaginal, laparoscopic, or robotic-assisted laparoscopic hysterectomy. In a robotic-assisted procedure, the surgeon directs the robot while seated at a console in the operating room. This differs from laparoscopic hysterectomy because a "robot" performs the operation, while the surgeon watches a monitor. This systematic review will compare quality of life (QOL) in patients who undergo total robotic-assisted laparoscopic hysterectomy for benign indications and those who undergo conventional laparoscopic surgery. METHODS: We will perform a systematic review according to the Cochrane Methodology for randomized controlled trials. The review will include studies reporting use of QOL metrics to assess patients who undergo total hysterectomy for benign indications using robotic-assisted technique or conventional laparoscopic surgery. QOL will be the primary outcome and will be measured using validated instruments. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases. Two reviewers will independently select the eligible studies, assess the risk of bias, and extract the data from included studies. Similar outcomes measured in at least 2 trials will be plotted in the meta-analysis using Review Manager 5.3. The quality of evidence will be determined using the GRADE approach. RESULTS: This systematic review is designed to provide high quality evidence on QOL in patients undergoing total hysterectomy for benign indications using either robotic-assisted or conventional laparoscopic surgery. CONCLUSION: It is expected that high-quality evidence on QOL can be used to guide decision-making by institutions and clinicians to improve health care; the evidence can also be used in future studies. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42019129913.

Depresión y ansiedad en mujeres histerectomizadas no oncológicas posterior a la cirugía / Depression and anxiety in non-cancer hysterectomized women after surgery

RESUMEN Introducción y objetivo: La histerectomía es la segunda cirugía ginecológica más frecuente, después de la cesárea, afectando a un importante porcentaje de la población femenina, con un gran impacto emocional. El objetivo de esta revisión es describir las consecuencias psiquiátricas y sus factores predisponentes, en las mujeres histerectomizadas no oncológicas posterior a la cirugía. Material y métodos: Se incluyeron investigaciones en inglés, español y portugués, con un máximo de 15 años de antigüedad. Se excluyeron investigaciones realizadas en mujeres histerectomizadas oncológicas y/o con antecedentes psiquiátricos previos a la cirugía. Resultados: Posterior a la histerectomía por causa benigna, aparecen trastornos depresivos y/o ansiosos en las mujeres en frecuencias variadas. En el post-operatorio inmediato de la histerectomía, se reportan prevalencias de hasta un 84% para depresión y hasta un 92% para ansiedad, respectivamente. En cuanto a los factores que predisponen a la incidencia de estos problemas, se encuentran; la paridad relacionado con la cantidad de hijos engendrados y el deseo de tener más hijos, la nuliparidad, la edad, la falta de información y educación previa a la cirugía, la soledad y escaso apoyo familiar, los mitos y creencias sociales en torno al procedimiento, entre otros. Conclusiones: El significado social del útero y el enjuiciamiento que vive la mujer histerectomizada, son factores relevantes en la aparición de trastornos depresivos y/o ansiosos. La importancia de la educación es esencial para el afrontamiento eficaz por parte de la mujer en este procedimiento.

ABSTRACT Introduction and objective: Hysterectomy is the second most frequent gynecological surgery, after caesarean section, affecting an important percentage of the female population, with a great emotional impact. The objective of this review is to describe the psychiatric consequences and their predisposing factors in non-oncological hysterectomized women after surgery. Material and methods: Research was included in English, Spanish and Portuguese, with a maximum of 15 years old. We excluded investigations carried out in oncological hysterectomized women and / or with psychiatric antecedents prior to surgery. Results: After hysterectomy due to benign cause, depressive and / or anxious disorders appear in women at varied frequencies. In the immediate postoperative period of the hysterectomy, prevalences of up to 84% are reported for depression and up to 92% for anxiety, respectively. As for the factors that predispose to the incidence of these problems, they are found; parity related to the number of children conceived and the desire to have more children, nulliparity, age, lack of information and education prior to surgery, loneliness and poor family support, myths and social beliefs about the procedure, among others. Conclusions: The social meaning of the uterus and the judgment of the hysterectomized woman are relevant factors in the appearance of depressive and / or anxious disorders. The importance of education is essential for effective coping by women in this procedure.

Pelvic organ prolapse patients' attitudes and preferences regarding their uterus: comparing German- and Russian-speaking women.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare preferences of patients with pelvic organ prolapse (POP) regarding their uterus between German- and Russian-speaking areas. METHODS: Six urogynecologic tertiary referral centers participated in this prospective study: three centers from German-speaking countries and three from different regions of Russia. To assess the uterus-related preferences as well as the attitude toward hysterectomy versus uterus-sparing prolapse surgery, we developed a structured questionnaire that included 5-point Likert scales related to benefit of uterus (BOU) and benefit of not having uterus (BNU). Each scale consisted of 12 items (range of possible scores: 12-60). Finally, patients were asked if they preferred uterus removal or preservation when undergoing prolapse surgery. RESULTS: One hundred and seventy-eight German-speaking and 206 Russian-speaking patients were included in the study. There was no significant difference in patients' preference before undergoing POP surgery regarding uterus preservation versus hysterectomy between German- and Russian-speaking patients: 40% of German-speaking and 54% of Russian-speaking patients preferred to retain their uterus before undergoing POP surgery. Comparison of BOU mean scores showed a significant difference between groups: 20.6 ± 6.7 for German-speaking compared with 32.5 ± 9.1 for Russian-speaking patients (p < 0.01). The Russian-speaking group had significantly higher mean scores on domains sexuality, body image, and partnership of the BOU scale (2.6 ± 1.0 vs. 1.8 ± 0.9 for sexuality; 2.4 ± 1.1 vs. 1.5 ± 0.7 for body image, and 2.6 ± 0.9 vs. 1.6 ± 0.7 for partnership domains; p < 0.05). CONCLUSIONS: Although a large proportion of German- and Russian-speaking patients prefers uterus preservation when undergoing prolapse surgery, the uterus was more important for sexuality, partnership, and body image in Russian-speaking patients.

Psychiatric comorbidities among endometrial cancer survivors in South Korea: a nationwide population-based, longitudinal study.

OBJECTIVE: This longitudinal study aimed to analyze the prevalence of mental disorders in endometrial cancer survivors in South Korea. METHODS: We assessed mental disorders in a nationwide cohort of 8,155 patients who were diagnosed with endometrial cancer between January 1, 2010, and December 31, 2014. We categorized the prevalence of mental disorders based on age and time of diagnosis. RESULTS: Based on the first diagnosis, mental disorders were identified in 567 (7.0%) among patients with endometrial cancer. Of those patients, 249 (43.9%) were diagnosed with depression and 248 (43.7%) with anxiety. The overall incidence of mental disorders peaked within 2 months after hysterectomy. The rate of stress reaction/adjustment disorder increased most rapidly among the mental disorders after hysterectomy. While depression rates were relatively high among younger individuals (under 50 years), anxiety was more frequent in older people (over 50 years old). In the entire prescription (n=6,034), depression had the highest incidence (n=3,801), followed by anxiety (n=1,774). Over 89% (n=5,362) of the mental disorder treatment claims were from psychiatric medical departments. CONCLUSION: Mental disorders showed different prevalence patterns among endometrial cancer survivors depending on patient age and the nature of the disease. Intensive and personalized management of distress is necessary for endometrial cancer survivors.

Predictors of goal achievement in patients undergoing hysterectomy.

OBJECTIVE: The primary objective of our study was to identify predictors of goal achievement in patients undergoing simple hysterectomy for benign indications. We also sought to describe the goals of patients in this population. STUDY DESIGN: This was a prospective cohort study of patients undergoing hysterectomy for benign indications performed at a single academic institution. We documented patient-reported goals of treatment prior to undergoing hysterectomy in 57 patients, and assessed goal achievement and other patient-centered outcomes three months after surgery in 47 of the patients (82.5%). We compared patients who met all of their goals to those who did not, and used multivariate regression to identify predictors of goal achievement. We also characterized the general profile of goals for patients undergoing hysterectomy. RESULTS: We identified the primary surgical diagnosis of abnormal uterine bleeding (OR 6.5, 1.7-30.1, p = 0.006), as well as an increased feeling of being prepared for postoperative discharge (OR 11.9, 2.1-104.4, p = 0.005), to be independent predictors of patient goal achievement. Goal achievement was correlated with other patient-centered outcomes, including a higher sense of satisfaction and greater patient global impression of improvement. Goals related to symptoms were more commonly stated and more commonly achieved than functional goals. CONCLUSION: Goal achievement in patients undergoing hysterectomy depends on the preoperative diagnosis and the patient's feeling of preparedness for postoperative discharge. Goal achievement should be considered as a useful patient-centered outcome. Patients undergoing hysterectomy have a unique profile of goals which should be considered and addressed in preoperative counseling.

Impact of Laparoscopic Hysterectomy on Quality of Life.

There is an ongoing debate regarding the benefits and drawbacks of the various routes of hysterectomy. A number of studies have examined overall quality of life outcomes as well as specific patient-reported outcomes including physical, psychosocial, and sexual functioning after hysterectomy. Existing studies have used varied methodologies with widely heterogeneous results, but patient satisfaction appears to be very high after laparoscopic hysterectomy, with many studies favoring the laparoscopic approach over other routes of hysterectomy. There are many opportunities for further investigation into the impact of laparoscopic hysterectomy on quality of life-an outcome measure that may be 1 of the most important in surgeries for benign indications.

Shared Decision-Making to Improve Patient Engagement in Minimally Invasive Hysterectomy.

Shared decision-making (SDM) between the patient and physician is receiving increased attention as a way to improve patient satisfaction and value of care. Having a readily implemented tool available to inform conversation may enable SDM at a high-volume gynecologic surgery practice. Our objective was to evaluate the impact of an SDM tool on patients' decision to have minimally invasive gynecology surgery. We conducted a feasibility study using the SDM tool plus a follow-up survey for 100 patients recommended to undergo minimally invasive hysterectomy. Nearly all patients (97%) indicated that they were satisfied with their decision to undergo a minimally invasive procedure, including laparoscopic total and supracervical hysterectomy with or without the aid of the robotic platform. Anecdotally, patients expressed appreciation for the provided materials and the presentation of care options. For the care provider, use of the SDM tool did not add substantial time to the visit. Knowing that comprehensive information was provided to all patients was reassuring. Implementing a shared decision-making model in a gynecological practice is feasible and increases awareness and engagement, as well as satisfaction, among patients electing to have a hysterectomy.