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

CPT4 code

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.

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

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