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Özberk H, Kurt S, Özmen S, Çetinbaş CT, Özberk İ. Sociodemographic characteristics associated with indications for surgical menopause in women: a retrospective study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230398. [PMID: 37820164 PMCID: PMC10561917 DOI: 10.1590/1806-9282.20230398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the surgical menopause indications and sociodemographic characteristics of women. METHODS In this retrospective study, we analyzed the sociodemographic characteristics of women with indications for surgical menopause in 2010-2020. The R Version 4.1.1 (2021-08-10) software and logistic regression analysis were used to evaluate the data. RESULTS A total of 704 women's data were obtained in this study. Surgical menopause indications were found to stem from bleeding (46.0%), cancer (28.3%), cancer risk (18.9%), and other causes (6.8%). Surgical menopause indications originating from cancer were increased by 0.08 times (95%CI 0.01-0.68) due to smoking, 0.45 times (95%CI 0.23-0.88) due to regular drug use, and 0.36 times (95%CI 0.19-0.69) due to the presence of chronic disease (p<0.05). CONCLUSION More than half of the women with surgical menopause indications were between 41 and 46 years of age. Additionally, 54.9% of the women had a chronic disease. Therefore, it is recommended to plan preventive health services for morbidity and mortality risks that may develop due to surgical menopause.
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Affiliation(s)
- Hülya Özberk
- Dokuz Eylül University, Faculty of Nursing, Department of Gynecologic and Obstetrics Nursing – İzmir, Turkey
| | - Sefa Kurt
- Dokuz Eylul University Hospital, Department of Obstetrics and Gynecology – İzmir, Turkey
| | - Samican Özmen
- Dokuz Eylul University Hospital, Department of Obstetrics and Gynecology – İzmir, Turkey
| | - Cansu Tuğçe Çetinbaş
- Dokuz Eylul University Hospital, Department of Obstetrics and Gynecology – İzmir, Turkey
| | - İsmail Özberk
- Ege University, Graduate School of Natural and Applied Sciences, Department of Statistics – İzmir, Turkey
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Orji P, Sun H, Isali I, Bell S, Zaorsky N, Mishra K, Gupta S, Correa A, Smaldone M, Calaway A, Viterbo R, Bukavina L. Female sexual function evaluation and intraoperative vaginal reconstruction in bladder cancer. World J Urol 2023; 41:1751-1762. [PMID: 37419972 DOI: 10.1007/s00345-023-04502-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 07/09/2023] Open
Abstract
RC significantly negatively impacts sexual function (SF) in both men and women. While significant research resources have been allocated to examine the deleterious effects of post prostatectomy erectile dysfunction, little attention has been directed towards female sexual function and organ preservation post cystectomy. These academic shortcomings often result in poor provider awareness and inadequate preoperative assessment. As such, it is crucial for all providers involved in female RC care to understand the necessary and available tools for preoperative evaluation, in addition to the anatomic and reconstructive techniques. This review aims to summarize the current preoperative evaluation and available tools of SF assessment and describe in detail the varying operative techniques in the preservation or restoration of SF in women after RC. The review explores the intricacies of preoperative evaluation tools, and intraoperative techniques for organ- and nerve-sparing during radical cystectomy in females. Particular emphasis on vaginal reconstruction after partial or complete resection is provided, including split-thickness skin (STF) graft vaginoplasy, pedicled flaps, myocutaneous flaps and use of bowel segments. In conclusion, this narrative review highlights the importance of understanding anatomic considerations and nerve-sparing strategies in promoting postoperative SF and quality of life. Furthermore, the review describes the advantages and limitations of each organ- and nerve-sparing technique and their impact on sexual function and overall well-being.
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Affiliation(s)
- Peace Orji
- Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Helen Sun
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ilaha Isali
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Spencer Bell
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Nicholas Zaorsky
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kirtishri Mishra
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shubham Gupta
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Andres Correa
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Marc Smaldone
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Adam Calaway
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rosalia Viterbo
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Laura Bukavina
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
- Department of Urologic Oncology, Fox Chase Cancer Center, Temple Health Medical Center, Philadelphia, PA, 19111, USA.
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Long AJ, Kaur P, Lukey A, Allaire C, Kwon JS, Talhouk A, Yong PJ, Hanley GE. Reoperation and pain-related outcomes after hysterectomy for endometriosis by oophorectomy status. Am J Obstet Gynecol 2023; 228:57.e1-57.e18. [PMID: 36029832 DOI: 10.1016/j.ajog.2022.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND More research is needed that compares the outcomes between those who underwent a hysterectomy for endometriosis with conservation of one or both ovaries and those who underwent a hysterectomy with bilateral salpingo-oophorectomy. OBJECTIVE This study aimed to compare the rate and types of reoperations (primary outcome) and use of other pain-related health services (secondary outcomes) among people who underwent a hysterectomy with conservation of both ovaries, those who underwent a hysterectomy with unilateral salpingo-oophorectomy, and those who underwent a hysterectomy with bilateral salpingo-oophorectomy. STUDY DESIGN This was a population-based, retrospective cohort study of 4489 patients aged 19 to 50 years in British Columbia, Canada, who underwent a hysterectomy for endometriosis between 2001 and 2016. Index surgeries were classified as hysterectomy alone (conservation of both ovaries), hysterectomy with unilateral salpingo-oophorectomy, or hysterectomy with bilateral salpingo-oophorectomy. Reoperation rate was the primary outcome. Secondary outcomes (measured at 3-12 months and 1-5 years after hysterectomy) included physician visits for endometriosis and pelvic pain, prescriptions filled for opioids, and use of hormonal suppression medications and hormone replacement therapy. RESULTS Reoperation rates were low across all groups, with 89.5% of all patients remaining reoperation free by the end of follow-up (median of 10 years; interquartile range, 6.1-14.3 years). Patients who underwent a hysterectomy alone were more likely to undergo at least 1 reoperation when compared with those who underwent a hysterectomy with bilateral salpingo-oophorectomy (13% vs 5%; P<.0001), most commonly an oophorectomy or adhesiolysis. When oophorectomy as reoperation was removed in a sensitivity analysis, this difference was partially attenuated (6% of hysterectomy alone group vs 3% of hysterectomy with bilateral salpingo-oophorectomy group undergoing at least 1 reoperation). All groups were very similar in terms of rates of physician visits for endometriosis or pelvic pain and the number of days of opioid prescriptions filled. Furthermore, the rate of hormonal suppression medication use was similar among the groups, whereas the rate of prescriptions filled for hormone replacement therapy after hysterectomy with bilateral salpingo-oophorectomy was 60.6% of patients who filled at least 1 prescription at 3 to 12 months after index surgery. CONCLUSION Patients who underwent a hysterectomy with bilateral salpingo-oophorectomy had a lower reoperation rate than those who underwent a hysterectomy with conservation of one or both ovaries. However, there was little difference between the groups for the secondary outcomes measured, including physician visits for endometriosis and pelvic pain, opioid use, and use of hormonal suppression medications, suggesting that persistent pelvic pain after hysterectomy for endometriosis may not differ substantively based on ovarian conservation status. One limitation was the inability to stratify patients by stage of endometriosis or to determine the impact of endometriosis stage or the presence of adnexal disease or deep endometriosis on the outcomes. Moreover, hormone replacement therapy prescriptions was not filled by about 40% of patients after hysterectomy with bilateral salpingo-oophorectomy, which may have significant health consequences for these individuals undergoing premature surgical menopause. Therefore, strong consideration should be given to ovarian conservation at the time of hysterectomy for endometriosis.
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Affiliation(s)
- Alicia J Long
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Paramdeep Kaur
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra Lukey
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice S Kwon
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aline Talhouk
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul J Yong
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Gillian E Hanley
- Department of Gynecology and Obstetrics, The University of British Columbia, Vancouver, British Columbia, Canada.
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Nishimi K, Thurston RC, Chibnik LB, Roberts AL, Sumner JA, Lawn RB, Tworoger SS, Kim Y, Koenen KC, Kubzansky LD. Posttraumatic stress disorder symptoms and timing of menopause and gynecological surgery in the Nurses' Health Study II. J Psychosom Res 2022; 159:110947. [PMID: 35644086 PMCID: PMC9197996 DOI: 10.1016/j.jpsychores.2022.110947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Earlier menopause, either natural or through gynecologic surgeries, has been associated with various negative health sequelae. While posttraumatic stress disorder (PTSD) has been linked to dysregulated biological processes, including reproductive system changes that could alter menopausal timing, little work has examined whether trauma and PTSD are associated with greater risk of early cessation of menses. METHODS Data are from 46,639 women in the Nurses' Health Study II, a prospective cohort study of women followed for up to 26 years. Lifetime trauma and PTSD symptoms were assessed with the Brief Trauma Questionnaire and a PTSD symptom screener in 2008. Age at cessation of menses and reason for cessation of menses (i.e., natural menopause, gynecologic surgery including hysterectomy and/or bilateral salpingo-oophorectomy [BSO]) were assessed. Cox proportional hazards models estimated hazards ratios (HR) of cessation of menses (separately for naturally or surgically) associated with trauma alone or PTSD symptoms, relative to no trauma, adjusting for covariates. RESULTS Trauma/PTSD status was associated with earlier cessation of menses due to surgery, but not natural menopause. Women with trauma exposure, low, and high PTSD symptoms had higher hazard of cessation of menses due to surgery relative to those with no trauma exposure (HRtrauma = 1.16, 95%CI 1.07-1.26; HRlow PTSD = 1.25, 95%CI 1.15-1.36; HRhigh PTSD = 1.29, 95%CI 1.17-1.42). Trauma exposure and PTSD symptoms were associated with similarly increased risk of hysterectomy and BSO surgeries. CONCLUSIONS Women who experienced trauma and PTSD may be at elevated risk for common gynecological surgeries premenopausally, potentially due to increased clinical indications or gynecological conditions.
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Affiliation(s)
- Kristen Nishimi
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA; Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lori B Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yongjoo Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Iancu AM, Murji A, Chow O, Shapiro J, Cipolla A, Shirreff L. Avoidable bilateral salpingo-oophorectomy at hysterectomy: a large retrospective study. Menopause 2022; 29:523-530. [PMID: 35324543 DOI: 10.1097/gme.0000000000001951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Evaluate the proportion of justified bilateral salpingo-oophorectomy (BSO) at hysterectomy, based on pathologic diagnosis, and determine prevalence of avoidable BSO based on pre- and intraoperative considerations and pathologic diagnosis. METHODS Retrospective review of hysterectomies at seven Ontario, Canada hospitals from 2016 to 2019. Surgeries completed by oncologists or for invasive placentation were excluded. Patient, case, and surgeon characteristics were recorded along with pathologic diagnoses. Avoidable BSO criteria were: preoperative diagnosis of cervical dysplasia or benign diagnosis other than endometriosis, gender dysphoria, risk reduction or premenstrual dysphoric disorder; age < 51 years; absence of intraoperative endometriosis and adhesions; unjustified pathology (where "justified" pathology was endometriosis or (pre)malignant diagnosis except for cervical dysplasia). Patients with avoidable BSO were compared to those having at least one criterion for BSO. Binary logistic regression identified factors most strongly associated with avoidable BSO. RESULTS Four thousand one hundred ninety-one hysterectomies were completed with 1,422 (33.9%) patients having concomitant BSO. Pathologic diagnosis justified BSO in most patients (1,035/1,422, 72.8%) with endometrial cancer being most common (439/1,422, 30.9%). When preoperative characteristics, intraoperative findings, and pathologic diagnoses were considered, 79 of 1,422 (5.6%) BSOs were avoidable. Compared to cases with at least one criterion for BSO, avoidable BSOs were more frequently completed by generalists (OR 1.80, 95% CI 1.10-2.99, P = 0.021), for preoperative diagnoses of abnormal uterine bleeding/menorrhagia (OR 3.82, 95% CI 2.35-6.30, P = 0.001) and fibroids (OR 4.25, 95% CI 2.63-6.92, P < 0.001). CONCLUSION Pathologic diagnosis justified most BSOs at hysterectomy. BSO was avoidable in 5.6% of patients, underscoring the need to standardize practice of BSO.
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Affiliation(s)
- Ana-Maria Iancu
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ovina Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jodi Shapiro
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Cipolla
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Trillium Health Partners, Toronto, Ontario, Canada
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Kaunitz AM, Faubion S. Surgical menopause: health implications and hormonal management. ACTA ACUST UNITED AC 2021; 28:1-3. [DOI: 10.1097/gme.0000000000001680] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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