Our Summary

This study looked at how different surgical treatments for a condition called pelvic organ prolapse (when pelvic organs like the bladder or uterus drop down) are used in different areas in the state of Michigan. The researchers examined medical records from three types of insurance, focusing on surgeries performed between 2015 and 2021. They found that there is a lot of variation in what type of surgery is used, depending on where in the state a patient lives.

The three types of surgeries they looked at were vaginal hysterectomy (removal of the uterus through the vagina), laparoscopic assisted vaginal hysterectomy (using a camera and small incisions to assist in removing the uterus through the vagina), and laparoscopic hysterectomy (removal of the uterus using a camera and small incisions in the abdomen). The proportion of women who had a vaginal hysterectomy varied widely, from 5.8% to 86.8% across the 78 counties in Michigan that were examined.

They also found that the type of surgery performed was linked to whether other procedures were done at the same time. For example, vaginal hysterectomy was more likely to be performed with a procedure to repair the walls of the vagina (colporrhaphy), but less likely to be done with a procedure to suspend the top of the vagina (colpopexy).

The researchers concluded that where a woman lives could influence the type of surgery she gets for pelvic organ prolapse. This may also explain the variation in whether additional procedures are performed as well. This shows that there is no standard approach to treating this condition and more research is needed to understand why these variations exist.

FAQs

  1. What were the three types of surgeries examined in the study for treating pelvic organ prolapse?
  2. How does the location of a patient in Michigan affect the type of surgery they receive for pelvic organ prolapse?
  3. Did the study find any link between the type of surgery performed and other procedures being done at the same time?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to discuss with their healthcare provider the different types of hysterectomy procedures available and the potential risks and benefits of each option. It’s important for patients to be well-informed and actively participate in the decision-making process regarding their treatment. Additionally, patients should ask their healthcare provider about the possibility of concurrent procedures being performed during the hysterectomy and how these additional procedures may impact their recovery and long-term outcomes. It’s crucial for patients to feel empowered to ask questions and seek clarification on any aspect of their treatment plan.

Suitable For

Patients who are typically recommended hysterectomy for pelvic organ prolapse include those who have failed conservative treatments such as pelvic floor physical therapy or pessary use, those who have significant symptoms that impact their quality of life, and those who have completed childbearing and do not wish to have future pregnancies. Additionally, patients with severe prolapse or other medical conditions that may make them poor candidates for other types of surgical treatments may also be recommended hysterectomy. Ultimately, the decision to recommend hysterectomy should be made on a case-by-case basis by the patient and their healthcare provider, taking into consideration the patient’s individual circumstances and preferences.

Timeline

In general, before a hysterectomy, a patient may experience symptoms such as pelvic pain, heavy menstrual bleeding, pelvic organ prolapse, or other gynecological issues. They will typically undergo a series of tests and consultations with their healthcare provider to determine if a hysterectomy is the best course of action.

After the surgery, the patient will have a recovery period, which can vary depending on the type of hysterectomy performed. They may experience some pain and discomfort, as well as potential side effects such as vaginal bleeding, infection, or changes in hormone levels. Over time, the patient should start to see improvements in their symptoms and overall quality of life. It is important for the patient to follow their healthcare provider’s instructions for post-operative care and attend any follow-up appointments to monitor their recovery progress.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hysterectomy include:

  1. What are the different types of hysterectomy procedures available for my condition?
  2. What are the potential risks and benefits of each type of hysterectomy procedure?
  3. How will the choice of hysterectomy procedure affect my recovery time and potential complications?
  4. Are there any alternative treatments to hysterectomy that I should consider?
  5. Will additional procedures, such as colporrhaphy or colpopexy, be performed at the same time as the hysterectomy?
  6. How will the choice of hysterectomy procedure impact my long-term pelvic health and quality of life?
  7. What factors will you consider when determining the best hysterectomy procedure for me?
  8. Are there any specific factors about my condition or health history that make one type of hysterectomy more suitable for me than others?
  9. Can you explain the reasons behind the variation in hysterectomy procedures seen in different areas, and how it may impact my treatment?
  10. What follow-up care and monitoring will be needed after the hysterectomy procedure?

Reference

Authors: Latack KR, Moniz M, Hong CX, Schmidt P, Malone A, Kamdar N, Madden B, Pizzo CA, Thompson MP, Morgan DM. Journal: Am J Obstet Gynecol. 2023 Sep;229(3):320.e1-320.e7. doi: 10.1016/j.ajog.2023.05.025. Epub 2023 May 25. PMID: 37244455