Recurrent pelvic organ prolapse after hysterectomy; a 10-year national follow-up study.

PURPOSE: Hysterectomy may be a risk factor for pelvic organ prolapse (POP). We assessed the risk of recurrent POP (operations and visits) after hysterectomy among women with previous POP. We also studied patient and operation related risk factors for POP recurrence. METHODS: This retrospective cohort study included 1697 women having previous POP diagnosis or POP at the time of hysterectomy (FINHYST 2006 cohort). Follow-up was until the end of 2016. The data was derived from the Finnish National Care register linked to the cohort. Hysterectomy approaches and other demographics were compared to the risk of a prolapse diagnosis and/or surgery. Cox regression model was used to identify hazard ratios. RESULTS: Following hysterectomy, a total of 280 women (16.5%) had a POP reoperation and 359 (21.2%) had an outpatient visit due to POP. Vaginal vault prolapse repair was the most common POP reoperation (n = 181, 10.7%), followed by anterior wall repair (n = 120, 7.1%). Median time to POP reoperation was 3.7 years. Hysterectomy approach did not affect reoperations or visits. Previous cesarean section and anterior repair during hysterectomy were associated with decreased risk, whereas concomitant sacrospinous fixation and uterus prolapse as the main indication led to increased risk of anterior/vault prolapse reoperations. Concomitant posterior repair decreased posterior reoperations and visits, but uterus weight over 500 g caused a fivefold increased risk of posterior prolapse visit. Residential status was associated with elevated risk of any POP reoperations and visits. CONCLUSIONS: Approximately one out of five women suffering from POP ensue POP reoperation or visit after hysterectomy. These high rates are independent on hysterectomy approach, but probably indicate that hysterectomy may worsen previous pelvic floor dysfunction.

Pelvic organ prolapse after hysterectomy: A 10-year national follow-up study.

INTRODUCTION: Hysterectomy may have an effect on the pelvic floor. Here, we evaluated the rates and risks for pelvic organ prolapse (POP) surgeries and visits among women with a history of hysterectomy for benign indication excluding POP. MATERIAL AND METHODS: In this retrospective cohort study 3582 women who underwent hysterectomy in 2006 were followed until the end of 2016. The cohort was linked to the Finnish Care Register to catch any prolapse-related diagnoses and operation codes following the hysterectomy. Different hysterectomy approaches were compared according to the risk for a prolapse, including abdominal, laparoscopic, laparoscopic-assisted vaginal and vaginal. The main outcomes were POP surgery and outpatient visit for POP, and Cox regression was used to identify risk factors (hazard ratios [HR]). RESULTS: During the follow-up, 58 women (1.6%) underwent a POP operation, of which a posterior repair was the most common (n = 39, 1.1%). Outpatient visits for POP symptoms occurred in 92 (2.6%) women of which posterior wall prolapses (n = 58, 1.6%) were the most common. History of laparoscopic-assisted vaginal hysterectomy were associated with risk for POP operation (HR 3.0, p = 0.02), vaginal vault prolapse operation (HR 4.3, p = 0.01) and POP visits (HR 2.2, p < 0.01) as compared to the approach of abdominal hysterectomy. History of vaginal deliveries and concomitant stress urinary continence operation were associated with the risk for a POP operation (HR 4.4 and 11.9) and POP visits (HR 3.9 and 7.2). CONCLUSIONS: Risk for POP operations and outpatient visits for POP symptoms in hysterectomized women without a preceding POP seems to be small at least 10 years after hysterectomy. History of LAVH, vaginal deliveries and concomitant stress urinary incontinence operations increased the risk for POP operations after hysterectomy. These data can be utilized in counseling women considering hysterectomy for benign indication.

Induced abortion has no psychological effect on early parental self-efficacy and psychological well-being: The Steps to the Healthy Development and Well-being of Children study.

INTRODUCTION: An association between a history of induced abortion and psychological well-being post-abortion has been demonstrated in recently published studies, which is contrary to the findings of existing known high-quality studies. MATERIAL AND METHODS: An evaluation was conducted to determine whether a history of abortion affected the psychological well-being and parental self-efficacy of first-time mothers and their partners; this assessment was performed when the child was aged 18 months. Questionnaires were administered to 492 first-time mothers, 37 of whom had a history of abortion, and their partners (n = 436). Women with previous miscarriages, ectopic pregnancies, and deliveries were excluded. The women were allocated to an abortion group or a comparison group, depending on each woman's abortion history obtained from medical birth registry data. Psychological well-being, which encompassed social and emotional loneliness, marital satisfaction, social phobia, and depression, was evaluated as a predictor of maternal and paternal self-efficacy within the two groups. The analysis was conducted using multi-group structural equation modeling. RESULTS: Induced abortion was not predictive of maternal or paternal well-being or parental self-efficacy. Overall, maternal and paternal psychological well-being was predictive of parental self-efficacy when an assessment was performed, regardless of an abortion history. After testing the invariance of multi-group models, psychological well-being was similarly found to predict parental self-efficacy in both the abortion history and comparison groups. CONCLUSIONS: These findings suggest that the psychological well-being of parents is an important predictor of maternal and paternal self-efficacy during toddlerhood. Abortion history was not demonstrated to negatively impact the psychological well-being of parents with respect to their capacity for parental self-efficacy.

Vaginal cuff dehiscence is observed in a higher rate after total laparoscopic hysterectomy compared with other types of hysterectomy.

INTRODUCTION: Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal. MATERIAL AND METHODS: A total of 13 645 hysterectomies from 1992 to 2015 were evaluated in the Turku University Hospital district, Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomy. The hysterectomy and postoperative vaginal dehiscence trends were analyzed as the secondary outcome. In a subanalysis of dehiscence cases, women's characteristics and perioperative vaginal cuff opening and closure techniques were compared between conventional hysterectomies (vaginal, abdominal, and laparoscopic with vaginal closure) and TLH. RESULTS: Altogether, 22 cases of vaginal cuff dehiscence were included. Most cases (n = 15) occurred after TLH (n = 1104), resulting in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure (n = 2853), vaginal (n = 4150), and abdominal (n = 5538) hysterectomies, the incidence rates were 0.11%, 0.05%, and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio (OR) 71.1 (9.34-541.38, P < 0.001). In the subanalysis of possible underlying factors, the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD were observed differences between TLH and conventional hysterectomies. CONCLUSIONS: Compared with other types of hysterectomies, vaginal dehiscence was observed at the highest rate after TLH. Studies are needed to define if vaginal opening technique contributes to the risk of dehiscence.

Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy.

INTRODUCTION AND HYPOTHESIS: Hysterectomy for benign indications can be performed either as a supracervical or a total procedure. It is controversial whether removing the cervix is beneficial or not. This study aimed at comparing long-term outcomes after supracervical (n = 107) and total (n = 105) abdominal hysterectomy. METHODS: Two prospective questionnaire-based studies were conducted among the original 212 patients operated on between February 1978 and May 1979 at Turku University Hospital, Finland. In the first study in 1997, a nonvalidated questionnaire was mailed to 193 patients to inquire about any postoperative symptoms. In the second study in 2011, a validated questionnaire and an invitation to a follow-up visit were sent to 153 women. During the visit, pelvic support was assessed using the Pelvic Organ Prolapse Quantification system. Additionally, hospital records were reviewed to identify any gynecological operations at both evaluation times. RESULTS: In the first evaluation, the response rate was 94 %, and in the second, the rate was 62 %. Objective evaluation was possible in 75 women in 2011, 37 in the supracervical group and 38 in the total hysterectomy group. There were no significant differences in the rates of subjective urinary and sexual symptoms or subsequent operations for urinary incontinence and genital prolapse between women in the supracervical group and women in the total hysterectomy group. Four patients in the supracervical group required a re-operation: three for a prolapsed cervical stump and one for a cervical abscess. CONCLUSIONS: Supracervical and total hysterectomies resulted in similar postoperative outcomes regarding subjective symptoms and subsequent gynecological operations during a follow-up of 33 years. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ( www.clinicaltrials.gov ): NCT02166749.

Surgery for stress urinary incontinence in Finland 1987-2009.

INTRODUCTION AND HYPOTHESIS: To estimate the incidence rates of stress urinary incontinence (SUI) surgery among Finnish women from 1987 to 2009 by age, and to evaluate the trends in SUI surgery. METHODS: We conducted a retrospective register-based study. All SUI procedures on adult women over age 18 years in Finland were identified from the nationwide Care Register for Health Care. Age-specific incidence rates per 1,000 women were calculated for each year. The cumulative incidence of SUI surgery was calculated. RESULTS: There were 38,340 procedures for SUI in 1987-2009. The overall age-adjusted incidence rate increased 2.6-fold from 0.5/1,000 women in 1987 to 1.3/1,000 in 2002, but declined thereafter by 2009 to 0.8/1,000. There was a six-fold increase in the incidence rate in the age group 60-69 years and a ten-fold increase in the age group 70-79 years from 1987 to 2002. These marked increases in operation rates coincided with the increased use of tension-free vaginal tape (TVT). In 2002, TVT accounted for 96 % of all SUI procedures. Mid-urethral slings with transobturator techniques surpassed TVT in popularity in 2007. The life-long cumulative incidence of SUI surgery was 9.9 % in 2002 and 6.3 % in 2009. CONCLUSIONS: The incidence rates of SUI surgery increased significantly in Finland, especially among women aged 60 to 79 years. Mid-urethral slings have become the dominant procedure.

Induced abortion - impact on a subsequent pregnancy in first-time mothers: a registry-based study.

BACKGROUND: To date, several studies concerning the effects of induced abortion (IA) on women's later psychosocial well-being and future delivery complications have been published. However, the lack of reports on woman's physical well-being during their first full-term pregnancy occurring after IA is what inspired the current study. Here, we evaluate the physical well-being and use of maternity services of first-time mothers with a history of IA. METHODS: Finnish National Birth Registry data from 2008 to 2010 were linked with the Induced Abortion Registry data from 1983 to 2007. After excluding first-time mothers with a history of miscarriage, ectopic pregnancy or delivery, 57,406 mothers were eligible for the study, with 5,167 (9.0 %) having experienced prior IA. Data from the pregnancy follow-up visits were evaluated and compared between IA mothers and primiparous mothers. RESULTS: Women with IA had higher rates of smoking after the first trimester and were more likely to be overweight (body mass index >25 kg/m2) than the control group mothers. A higher use of maternity health clinic (MHC) services, thrombosis prophylaxis and participation in a second trimester ultrasound and amniotic fluid sample testing were evident in IA mothers, whereas the likelihood of assisted fertilisation procedure(s) was elevated in the control group. A shorter interpregnancy interval (IPI) seemed to contribute to a late first MHC visit and first trimester serum screening test participation, a higher incidence of placenta samples and an increased presence of preeclampsia and maternal care for poor foetal growth. CONCLUSIONS: IA is associated with being overweight before the subsequent pregnancy and with smoking after the first trimester. More frequent pregnancy follow-up visits in the IA group may be due to greater participation in the placenta sample testing and use of thrombosis prophylaxis. No association between IA and preeclampsia, hypertension, gestational diabetes or preterm premature rupture of membranes was evident in the pregnancy parameters. According to our findings, experiencing IA decreased the need for fertilisation procedures before the next pregnancy when compared to primiparous mothers. Among the IA mothers, the short IPI seemed to contribute to the higher risk for preeclampsia and maternal care for poor foetal growth. However, more research is needed around the IPI before establishing its effect on later pregnancy.

Hysterectomies in Finland in 1990-2012: comparison of outcomes between trainees and specialists.

OBJECTIVE: To assess trends for hysterectomy methods in the Nordic countries and to compare outcomes of hysterectomies in Finland done by trainees with those done by specialists. DESIGN: Register-based study. SETTING: NOMESCO database for the Nordic countries and the Finnish Hospital Discharge Register. POPULATION: National prospective cohort of 5279 hysterectomies in Finland. METHODS: Numbers of hysterectomies in the Nordic countries were collected in 1995-2011 and in Finland in 1990-2012. The Finhyst study to collect data on hysterectomies for benign indications was carried out in Finland in 2006. Information concerning patients, surgeons, and hysterectomy outcome was analysed. MAIN OUTCOME MEASURES: Hysterectomy numbers and methods. Operating time, blood loss, and complications in hysterectomies done by trainees and specialists. RESULTS: In Finland, the rate of hysterectomies has been reduced by approximately 50% since the 1990s and is now similar to that in the other Nordic countries. The laparoscopic method is twice as common in Finland as in other Nordic countries, constituting 35-40% of all hysterectomies. The operating time for all hysterectomy methods was 16-25% longer among trainees than specialists. For the abdominal or laparoscopic methods there were no significant differences in the complication rates between the groups. In the vaginal approach, blood loss of ≥1000 mL was slightly more common in operations done by trainees (1.3% vs. 2.6%, p = 0.037). CONCLUSIONS: Laparoscopic hysterectomy is more common in Finland than in the other Nordic countries. Although trainees need more time to operate, there were no differences between the trainees and the specialists with regard to major complication rates.

[Update on Current Care Guidelines: Ectopic pregnancy]. / Ektooppinen (kohdunulkoinen) raskaus.

Ectopic pregnancy should be suspected it a woman of fertile age has lower abdominal pain and irregular vaginal bleeding. Symptoms range from almost none to shock. The diagnosis is based on a quantitative serum pregnancy test (hCG) and transvaginal ultrasound. An acute situation requires emergency surgery, whereas patients with mild symptoms should be treated policlinically by follow-up or a single intramuscular dose (1 mg/kg) of methotrexate. No folic acid supplementation is needed. In later pregnancies their location should be verified by transvaginal ultrasound done by the seventh gestational week at the latest.

[Achievement of educational goals among the trainees of obstetrics and gynaecology in the university of Turku]. / Miten Turun yliopistosta valmistuvat gynekologit ovat saavuttaneet koulutustavoitteensa?

This survey evaluates how the requirements in OB-GYN training are fulfilled in the University of Turku, Finland. We analysed the interventions and procedures performed by ten trainees who completed their specialisation between 2006 and 2009. The analysis was based on the EBCOG-Log Books. According to our survey the minimum requirements are better fulfilled in obstetrics compared to gynaecology. There is an imbalance between the EBCOG theoretical demand and practical performance of the trainees in gynaecology because of limited possibilities to perform traditional operations to the required extent. Consequently, gynaecological aspects in training need more resources and new alternative activities.

Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection.

OBJECTIVE: To evaluate sexual function, quality of life and pelvic pain after endometriosis surgery including vaginal resection. DESIGN: Prospective observational study with 12 months follow up. SETTING: Regional central hospital and university hospital. POPULATION: Twenty-two patients with deep endometriotic nodules in the posterior fornix of the vagina undergoing complete excision of endometriosis, including vaginal resection. METHODS: Sexual functioning was measured with the McCoy Female Sexuality Questionnaire, quality of life with a generic questionnaire (15D) and pain with a 10-point visual analog scale. Questionnaires were completed before and 12 months after the surgery. Main outcome measures. Changes in sexual function scores, quality-of-life scores and pain. RESULTS: Twelve months after surgery, the sexual satisfaction score was higher (p= 0.03) and the sexual problems score lower (p= 0.04) compared with baseline values. Health-related quality-of-life scores for discomfort and symptoms (p= 0.001), distress (p= 0.04), vitality (p= 0.03) and sexual activity (p= 0.001), and the overall 15D score (p < 0.001), were significantly improved. The severity of all studied types of pain was significantly decreased (p < 0.05). CONCLUSIONS: Complete excision of endometriosis, including vaginal resection, seems to offer a significant improvement in sexual functioning, quality of life and pelvic pain in symptomatic patients with deeply infiltrating endometriotic nodules in the posterior fornix of the vagina. This surgery may be associated with complications and adverse new-onset symptoms, and should be performed only after thorough consultation with the patient.

Hospital-diagnosed late sequelae after female Chlamydia trachomatis infections in 1990-2006 in Turku, Finland.

BACKGROUND: Rather little is known about the late sequelae of previously detected female Chlamydia infections. METHODS: The late sequelae of previous female Chlamydia infections detected during a 15-year period in a south-western Finnish university hospital were surveyed. Hospital records of women with positive laboratory diagnoses of Chlamydia trachomatis as a sign of genital infection were collected from the years 1990-2006 and subsequently linked to known or suspected in-hospital-treated late Chlamydia complications. RESULTS: The annual number of late complications has increased in proportion to the increasing trend of detected Chlamydia cases. 239 late complications of the total of 4,920 previously detected Chlamydia-positive infections were observed. The most frequent in-hospital-treated complications were disturbances in early pregnancy (n = 72) and low abdominal pain (n = 67). The others were 45 genital tract or pelvic infections, 34 cases of tubal or unknown infertility and 21 complications of late pregnancy and delivery. CONCLUSION: The late sequelae of Chlamydia infections need increasing attention in hospitals.

FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors.

BACKGROUND: Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH). METHODS: A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics. RESULTS: Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38-4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06-7.83) and with a large uterus ≥500 g (OR 2.88, 95% CI 1.05-7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17-117.88). CONCLUSIONS: FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.

Endogenous testosterone and brachial artery endothelial function in middle-aged men with symptoms of late-onset hypogonadism.

In aging men, serum endogenous testosterone is inversely associated with common carotid intima-media thickness (IMT) and directly with beneficial plasma lipid levels; however, the relationship to endothelial function is poorly characterized. We examined the association between serum testosterone and endothelium-dependent brachial artery flow-mediated dilatation (FMD) in middle-aged to elderly men. A group of 83 men aged 40?69 years (mean 55.9 ± 7.5 [SD]) with andropausal symptoms were studied. We measured their serum lipids, testosterone, luteinizing hormone, mean carotid IMT and brachial artery FMD by high resolution B-mode ultrasound. Brachial FMD correlated inversely with vessel diameter (r = -0.38, p = 0.0004), alcohol consumption (r = -0.22, p = 0.047) and serum testosterone (r = -0.27, p = 0.01), but not with luteinizing hormone. In multivariate analysis, FMD was explained by testosterone (ß = -0.17, p = 0.0226), high density lipoprotein cholesterol (ß = 4.17, p = 0.0312) and vessel diameter (ß = -4.37, p < 0.0001) when adjusted for age, body mass index, triglycerides, blood pressure, carotid IMT, smoking, alcohol consumption, cardiovascular diseases and use of lipid lowering medication (HMG-CoA reductase inhibitors). In middle-aged to elderly men, there is an inverse correlation between serum testosterone and brachial FMD. These data suggest that testosterone may have an adverse effect on systemic endothelial function.

Deeply infiltrating disease in surgically treated endometriosis patients.

OBJECTIVE: To examine the incidence of deeply infiltrating endometriotic lesions among surgically treated endometriosis patients, and determine clinical parameters associated with the presence of deep disease. DESIGN: Prospective observational study. SETTING: Regional central hospital. POPULATION: Patients undergoing surgical treatment of endometriosis. METHODS: Complete excision of all visible endometriotic lesions and adhesions. MAIN OUTCOME MEASURES: The number and location of deep lesions, association between the presence of deep lesions, relevant preoperative and intraoperative factors. RESULTS: Of 201 surgically treated endometriosis patients, 103 (51.2%) had deep lesions, 43.3% had uterosacral ligament deep lesions, 18.4% intestinal, 15.4% rectovaginal, and 3.5% urinary bladder deep lesions. Patients with deep lesions had more often undergone previous operations for endometriosis (p<0.01), had been operated on for pelvic pain (p<0.01) and had a totally obliterated rectovaginal pouch (p<0.01), compared to patients without deep lesions. In multivariate analysis, pelvic pain as an indication for surgery (OR 3.9, 95%CI 1.8-8.9, p<0.01) and totally obliterated rectovaginal pouch (OR 4.0, 95%CI 1.7-9.4, p<0.01) were independent prognostic factors for the presence of deep disease. CONCLUSIONS: Deeply infiltrating endometriosis is common in surgically treated endometriosis patients and should be searched for in those with persistent pelvic pain and where obliteration of the rectovaginal pouch is detected at surgery.

Change in the frequency of HRT use from 2000 to 2005 and reasons to discontinue: follow-up of a normal cohort in Finland.

OBJECTIVE: To examine frequencies of the use of hormone replacement therapy (HRT) in a follow-up cohort of women aged 57-61 years in 2005 and to discover reasons why the women who used HRT in 2000 discontinued it. DESIGN: Questionnaire survey. SETTING: Five-year cross-sectional follow-up study. SAMPLE: Cohort of 52- to 56-year-old Finnish women. METHODS: Single- and multi-predictor model analyses. MAIN OUTCOME MEASURES: Frequency of HRT users and quitters and reasons behind the discontinuation. RESULTS: Altogether, 35.9% of the women aged 57-61 years used HRT in 2005. Main reasons for the initial use of HRT among users and among those who discontinued included the perceived experience of severe climacteric symptoms as well as maintenance of health and prevention of mostly cardiovascular diseases. Main reasons to discontinue HRT included desire to stay without medication, side-effects, reaction to recent controversial findings in 'HRT publications' and fear of cancer. Those women who used but discontinued HRT had used it for less time than those who continued. Women who discontinued were older and initially started using HRT to maintain health. Neither the severity of climacteric symptoms nor reporting on positive or negative effects prior to starting use had influence on the women's discontinuance of HRT. CONCLUSIONS: The use of HRT was still frequent in Finland in 2005 despite the impact of controversial research results from the early 2000s. For those who discontinued HRT, these reports played an important role.

Climacteric symptoms more severe in 2010 than in 2000 - experience of Finnish women aged 52-56 years not now or previously on menopausal hormone therapy.

OBJECTIVES: To analyze and compare the experience of climacteric symptoms and their associations with sociodemographic and health-related characteristics in two cohorts of Finnish women aged 52-56 years, born ten years apart and not now or previously on menopausal hormone therapy (MHT). STUDY DESIGN: Nationwide population-based time-trend study with a large number of participants (n = 1986 + 1988). MAIN OUTCOME MEASURES: The experience of climacteric symptoms was assessed by 12 commonly used menopause-related symptoms. RESULTS: Women aged 52-56 experienced more moderate or severe symptoms and fewer mild symptoms in 2010 than in 2000. Being unemployed or inactive was associated with more severe symptoms (P = 0.007), but employment status had no effect on the relative odds estimates. CONCLUSIONS: The influence of the birth cohort and time-period effects as well as work-related factors on the experience of climacteric symptoms in women not now or previously on MHT needs further research, particularly since the change in the experience of symptoms found in this study occurred within only ten years.

Tension-free vaginal tape - a suitable procedure for patients with recurrent stress urinary incontinence.

OBJECTIVE: To evaluate the efficacy of the tension-free vaginal tape operation (TVT) in patients with and without previous anti-incontinence surgery. DESIGN: Prospective follow-up study. SETTING: University hospital in Finland. POPULATION: A total of 130 women who had a TVT procedure from August 1998 to December 2002. MAIN OUTCOME MEASURES: Subjective cure, complications and voiding symptoms. METHODS: Sixty women with recurrent (group A) and 70 women with primary stress urinary incontinence (SUI) (group B) were compared. One follow-up visit took place two months postoperatively and a questionnaire-based evaluation was carried out three years after operation. Further information was collected a mean of eight years after the operation. RESULTS: There was no difference in the transient postoperative retention rate (17 vs. 19%, p = 0.78) and number of complications (20 vs. 13%, p = 0.29) between group A and group B. At two months after operation, 85% of patients in group A and 94% in group B were cured of SUI and were satisfied with the operative result (p = 0.096). The satisfaction rates at three years were 86 and 91% in groups A and B, respectively, and cure rate of SUI was 93% in both groups. At follow-up, 20% of the patients in group A and 5.7% in group B (p = 0.013) had de novo urge symptoms and the rate of voiding difficulties increased especially in group B women over time. CONCLUSIONS: TVT results in the same cure and complication rates when performed for primary SUI and recurrent SUI. The procedure is effective and associated with a low and acceptable level of complications. It is well suited to treat also recurrent SUI.

Psychological behavior patterns and coping with menopausal symptoms among users and non-users of hormone replacement therapy in Finnish cohorts of women aged 52-56 years.

OBJECTIVE: To identify subgroups of women who differ with respect to self-evaluated stress, hostility, optimism and sense of coherence, and to identify differences, if any, in whether these subgroups use or do not use hormone replacement therapy (HT). STUDY DESIGN AND METHODS: This time-trend study is based on the Finnish national HeSSup study, in which nationwide cohorts of Finnish women aged 52-56 years randomly selected in 2000 (n = 1321) and in 2010 (n = 1389) responded to postal questionnaires related to four psychological behavior patterns. MAIN OUTCOME MEASURES: Relationships between psychological behavior patterns (stress, hostility, optimism and sense of coherence) and how menopausal symptoms are experienced and how this relates to the use of HT. RESULTS: The proportion of HT users was higher among those with more stress and hostility and less optimism and sense of coherence than among those low in stress and hostility and high in optimism and sense of coherence. CONCLUSIONS: Differences in psychological behavior patterns influence the perception of menopausal symptoms and the use of HT. When the treatment of women at menopause is planned, psychological behavior patterns should be considered, as these reflect the ability to cope with menopausal symptoms.

FINHYST 2006--national prospective 1-year survey of 5,279 hysterectomies.

BACKGROUND: In Finland, the number of hysterectomies during one decade has decreased by 34%. The national prospective FINHYST study in 1996 showed abdominal hysterectomy (AH) as being most common: 58%. In Finland since 2002, vaginal hysterectomy (VH) has been most preferred, with laparoscopic hysterectomy (LH) surpassing AH in 2005. METHODS: FINHYST 2006 is a national prospective hysterectomy study in which all hospitals collaborated from 1 January to 31 December 2006. Questionnaires, completed by gynaecologists, covered their experience, patient characteristics and surgical data. RESULTS: The 5279 hysterectomies distributed by approaches were 44% VHs, 32% LHs and 24% AHs. Less than 2% were subtotal. The main indications for hysterectomy were myomas (33%), uterine prolapse (28%) and menorrhagia (21%). The main indication for VH was not related to uterine prolapse in 39%. Bilateral salpingo-ooforectomy was performed in 36% of AHs, 32% of LHs and 2% of VHs. Antibiotic prophylaxis was used in 97%, and thrombosis prophylaxis in 65%. Haemorrhage was least and operation time shortest with VH, and hospital stay and sick leave were shortest after LH. CONCLUSIONS: In Finland, less invasive approaches comprise 76% of hysterectomies. This trend has resulted nationally in shortening of hospital stay and of convalescence time.