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
- Anesthesia: The patient receives general or regional anesthesia.
- Vaginal Access: A speculum is inserted to visualize the vaginal canal.
- Uterine Removal: The surgeon detaches the uterus from the surrounding tissues and removes it through the vaginal opening.
- 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.
- 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.