58267 Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control

Name of the Procedure:

Vaginal hysterectomy for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control.

Summary

A vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina. When performed with colpo-urethrocystopexy, it also addresses issues of urinary incontinence by supporting the urinary bladder and urethra, using techniques such as the Marshall-Marchetti-Krantz (MMK) or Pereyra methods.

Purpose

Medical Condition:

• Uterine disorders such as fibroids, heavy bleeding, or cancer.
• Pelvic organ prolapse.
• Stress urinary incontinence.

Goals:

• Remove the problematic uterus.
• Provide supportive measures to the bladder and urethra to alleviate urinary incontinence.
• Restore normal anatomical positioning and function.

Indications

• Symptomatic uterine fibroids.
• Uncontrolled abnormal uterine bleeding.
• Uterine prolapse.
• Stress urinary incontinence not resolved by non-surgical means.
• Patients who have completed childbearing.

Preparation

• Fasting for at least 8 hours prior to surgery.
• Discontinue certain medications, as advised by the doctor.
• Complete pre-operative blood tests, pelvic examination, and imaging studies.
• Discuss any allergies or health conditions with the surgical team.

Procedure Description

1. Anesthesia: The patient receives general or regional anesthesia.
2. Vaginal Access: A speculum is inserted to visualize the vaginal canal.
3. Uterine Removal: The surgeon detaches the uterus from the surrounding tissues and removes it through the vaginal opening.
4. Colpo-urethrocystopexy (MMK or Pereyra): Techniques to support the bladder and urethra are employed. Sutures or surgical mesh may be used to stabilize these structures.
5. Endoscopic Control (if used): An endoscope may be inserted to ensure proper placement and function.

Duration

The procedure typically takes between 1.5 to 3 hours.

Setting

Performed in a surgical center or hospital operating room.

Personnel

• Surgeon (Gynecologist).
• Anesthesiologist.
• Surgical nurses.
• Surgical technician.

Risks and Complications

Common Risks:

• Pain.
• Bleeding.

• Infection.

  Rare Risks:

• Injury to surrounding organs (bladder, bowel).
• Blood clots.
• Urinary dysfunction.
• Long-term pelvic pain.

Benefits

• Relief from uterine conditions like fibroids or prolapse.
• Improved quality of life by resolving stress urinary incontinence.
• Restoration of normal pelvic anatomy.

Recovery

• Hospital stay of 1-2 days.
• Use of pain management strategies.
• Avoid heavy lifting and strenuous activities for 4-6 weeks.
• Follow-up appointment to ensure proper healing.

Alternatives

• Non-Surgical: Medications, pelvic floor exercises, pessary devices.

• Surgical: Abdominal hysterectomy, laparoscopic hysterectomy.

  Pros and Cons:

• Non-Surgical: Less invasive but might not be as effective for severe cases.
• Other Surgical Options: May have different recovery times and risks.

Patient Experience

During the procedure, patients are under anesthesia and will not feel anything. Post-operatively, they may experience mild to moderate pain managed with medications. Gradual return to normal activities is anticipated, with full recovery taking several weeks. Patient comfort is a priority, with measures in place for pain management and support.