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Hysterectomy w/cervic removal and uringary frequency or incontinence Hysterectomy w/cervic removal and uringary frequency or incontinence

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  #1  
Unread 03-08-2003, 08:01 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

I've lived with urinary frequency all my life. Occasionally have endured urinary urgency as well. Now I'm sitting on a possible hysterectomy. I'm 60, 10 years post menopause, so of course, they want to take the ovaries as well and I have no problem with that, I guess, since the reason for the hysterectomy is a 5cm simple cyst on the left ovary that is very slow growing but has increased slightly in size since its discovery last July.

Surgery for a partial obstruction of the small intestine at an old bypass resection site was also recommended a couple of years ago but I refused that surgery and have been doing well.

I'm thinking of agreeing to the hysterectomy w/the proviso that a colorectal surgeon be on hand to take a good look at the intestines and IF the bypassed loop can be resected, and maybe a strictureplasty at the partial obstruction w/o removing the ileocecal valve, cecum and some small part of the colon, to go ahead and do so. If the intestine can't be resected w/o distrubing the ICV, etc. then the colorectal surgeon to just bow out and let the gyn do his thing.

But now I've developed some urinary tract or bladder problems. We haven't found the source for that yet.

I do NOT want to increase the urinary frequency problems nor aggravate whatever is going on with the urinary tract so am cooling to the idea of agreeing to ANY surgery and just continue the wait and watch approach w/the simple cyst. The gyn/onco and one website I found are comfortable with a wait and watch approach of a simple cyst up to 8cm. At 8cm surgery is recommended. Most gyns and websites list 4-5cm as the cut off decision for a simple cyst in post menopausal women.

I am curious as to how many who retained their cervix while "donating" the rest of their reproductive organs have had problems with urinary frequency, urgency or incontinence vs those who had their cervix removed as well and urinary problems.

I'd like to educate myself and make some decisions about this while I still have time to thoroughly explore my options.
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  #2  
Unread 03-08-2003, 08:11 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

I can only speak about my personal experiences. At the time of surgery, I was 50 and seemed to urinate more often than
others anyway. I had my cervix removed along with the
TAH/BSO, and I experienced horrible urinary frequency and
urgency. After experimenting with HRT and researching, I
learned that urgency can be caused by low estrogen levels.
Then, I experimented with vaginal estrogen since that is often required for the vaginal tissues in addtion to a systemic
estrogen. What I found to help me the most was the estring.
It is a devise you wear for 3 months, and then change it.
It releases a very small amount of estrogen directly to the
vaginal area on a daily basis. When I tried other vaginal
gels and vagifem where you work your way up to using it
only 2 or 3 times a week, it was not strong enough for me.
In order to help me with the urinary frequency, I really needed
the daily vaginal dosage from the estring.
I really don't know whether or not there is a connection between urinary frequency/urgency and keeping or losing the cervix. That is an interesting question!Good luck with your decision and your research!!!
  #3  
Unread 03-08-2003, 08:41 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

dear crohnietoo,

I had suffered from stress incontinence for many years and in the years before my surgery, my urinary symptoms got worse, to the point where I think I also had urge incontinence. I had to wear a pad every day and would leak even when walking. Sometimes when exercising, I had terrible pressure feelings and had to stop.

I had numerous fibroids and my problems improved significantly after my TAH/BSO. I still need to wear a tampon and small pad when doing vigorous exercise (soccer; running). Kegels have also helped me and I do them fanatically, even while exercising. The next step for me would likely be biofeedback sessions. I think I'm likely facing more drastic measures at some point down the road, but I can definitively say that the surgery improved my quality of life in that area quite a bit.

You seem very well informed about your options, and I have a question for you: have your docs offered any explanation or suggestions regarding your urinary symptoms? Was there any discussions of bladder support surgery too? Have you seen a urologist? If not, it sounds as if you should consider seeing one or a uro-gyn and having this specific problem evaluated.

I feel for what you're going through, since this is an embarrassing and life-inhibiting problem....

I guess, basically, since you seem to have some reservations about the TAH/BSO and your docs are comfortable with watching and waiting, that might be the way to go, unless/until your symptoms become unbearable.

best wishes...
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  #4  
Unread 03-08-2003, 09:23 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

Dear CrohnieToo,

I'm sorry but I do not have a lot of light to shed on this for you. When I had my hyst., they took my cervix. I started having bladder problems after my hyst.

I really like the idea of you seeing a Urologist, or a Uro-Gyn. They may be able to help you a great deal.

I like that fact that you are 'watching/waiting' while you learn more about the treatments/options available to you.

I wish you all the best....S
  #5  
Unread 03-08-2003, 10:02 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

((CrohnieToo)),
I'm sorry you are having so many problems Good for you for doing your research tho I had my cervix removed at the time of my Hyst as well. If I could do it over, from all I've learned, I would've retained it. It does provide support for your bladder & Vaginal vault. I have been experiencing symptoms of prolapse for the last several months. Also, since my Hyst, the urge & frequency of urinating have increased dramatically... There is some good info on the net pertaining to urger incontinence post-hyst & reasons to retain your cervix. Here are some good sites I have found that are very informative:

Before You Have A Hysterectomy:
http://womenshealth.miningco.com/cs/...sterectomy.htm

What You Don’t Know Can Hurt You: Knowledge Is Power In A Doctor/Patient Relationship:
http://www.obgyn.net/displayarticle....ort/comfort006

Abdominal Hysterectomy, Trends, Analysis: http://www.obgyn.net/ah/articles/special_5-99.htm

Retaining The Cervix at the time of Hysterectomy: http://www.icsoffice.org/publication...RS/QOL/319.htm

Understanding Hysterectomy-Dr. Susan Tannenbaum:
http://www.uhmc.com/tgynst02.htm

Hysterectomy associated with urge incontinence: http://www.womens-health.org.nz/whws...tm#hysterect62

Urinary incontinence higher after hysterectomy: http://www.womens-health.org.nz/whwsep00.htm#urinary

Hysterectomy increases risk of urge incontinence:
http://www.orgyn.com/news/2002/week_...my_increas.asp

Discusses the special balancing concerns of the first three months after a hyst:
http://www.geocities.com/NoLinks/balpo.htm

Urethral Syndrome:
http://www.duj.com/cystitis.html

Health Services Research on Hysterectomy and Alternatives:
http://www.ahcpr.gov/research/hysterec.htm
Hysterectomy-Increases Risk of Incontinence Later In Life:
http://report.kff.org/archive/repro/...kr000817.8.htm

The Impact of Hysterectomy on Sexual Life of Women:
http://www.athenainstitute.com/sciencelinks/acog01.html

The Cervix and Hysterectomy-Dr. J. Glen Bradley
http://www.obgyn.net/women/articles/...anter_0512.htm

Cervix Fact Sheet:
http://www.gcsq.org.au/qcgc/cervix/fact_sheet.asp

Vaginal Cuff Closure with Abdominal Hyst:
http://www.obgyn.net/displaytranscri...nesbitt_watson

Here are some sites I also have on Ovarian cysts I thot you might be interested in:

http://www.emedicine.com/aaem/topic331.htm
http://s.ivillage.com/health/lnav/cy...166054,00.html
http://www.ehendrick.org/healthy/00044670.html
http://med.chungbuk.ac.kr/~jeong/ghks/huge.htm
http://www.gynob.com/GBU2000b.htm
http://www.cyst101.com/summary.htm
http://www.nlm.nih.gov/medlineplus/e...cle/001504.htm
http://www.alphalink.com.au/~paman/page64.html
http://womenshealth.about.com/librar...ariancysts.htm
http://www.tjclarkinc.com/d_ovarian_cysts.htm
http://health.yahoo.com/health/centers/women/index.html
http://www.nezhat.com/hormther_.htm#c10
http://www.arcfertility.com/infertil...l_therapy.html
http://www.gynsecondopinion.com/OvarianCysts.shtml
http://www.reproductivecenter.com/cysts.html
http://www.obgyn.net/displayarticle..../ovarian-cysts
http://womenshealth.about.com/librar...y/aa111998.htm

Ovarian Cysts -- What Are They, And What To Do About Them:
http://www.obgyn.net/displayarticle....ey/banter_0708

Laparoscopy for ovarian cysts:
http://12.31.13.84/library/healthgui...?HWID=hw199854
FAQ'S-Ovarian cysts:
http://www.womenshealthmatters.ca/ce...an_cysts/FAQs/

Ovaries:
http://s.ivillage.com/health/lnav/ov...416874,00.html

Gynecologic Causes of Pain - Internal: In Pelvis or Abdomen: http://www.obgyn.net/displayarticle....indman_gynpain

Unilocular Ovarian Cysts Common, Rarely Malignant:
http://obgyn.net/ads/url.cfm?http://...=aqo030380501d

bladder diary:
http://www.dukeuroandgyncare.com/diar.html

Making the decision about treatment for urinary incontinence in women:

http://12.31.13.84/library/healthgu...p?HWID=aa137467

Urinary Incontinence in Women:


http://12.31.13.84/library/healthgu...p?HWID=hw220313
Types of Urinary Incontinence:

http://www.bidmc.harvard.edu/obgyn/...ation.asp#types

Possible Causes of Urinary:
http://www.bidmc.harvard.edu/obgyn/...on.asp#possible

What You Can Do to Help Your Incontinence:

http://www.bidmc.harvard.edu/obgyn/...nation.asp#what

Surgical Procedures for Stress Incontinence:

http://12.31.13.84/library/healthgu...p?HWID=hw219880


Incontinence Caused by Fistula:

http://www.mcevoy.demon.co.uk/Medic...IncntUFist.html


Treatment options:

http://www.dukeuroandgyncare.com/trea_ui.html

http://www.dukeuroandgyncare.com/trea_bladder.html

Incontinence Surgery:

http://www.gyndr.com/incontinence_surgery.htm

Laparoscopic and Minimally Invasive Procedures:
http://www.urogynecologychannel.com/lap_proc.shtml

http://www.obgyn.net/displayarticle...dures#lap_proc4

Treating women with urinary incontinence and prolapse:

http://www.mybladdermd.com/URPS.htm

http://www.urogynecologychannel.com/laparo.shtml

Dropped Bladder:

http://www.hisandherhealth.com/arti...d_bladder.shtml

Burch procedure:

http://www.obgyn.net/displayarticle...dures#lap_proc3

Urinary Incontinence:

http://12.31.13.84/library/healthgu...p?HWID=hw220313

Types of Urinary Incontinence in Women

http://physicaltherapy.about.com/li...ncontinence.htm

Urinary Incontinence in Women--How it is diagnosed

http://physicaltherapy.about.com/li...ontinencerx.htm

Urinary Incontinence Treatment Options for Women

http://physicaltherapy.about.com/li...s=Urinary+Sling

Do You Really Need That Hysterectomy?
http://beckysingleton.com/doctor5.htm

Questions to Prepare for_Surgery:
http://www.nypirg.org/health/surgery.html

Interstitial Cystitis - Pelvic Pain from the Bladder:
http://www.wdxcyber.com/nurine04.htm

Family History Important for Ovarian Cancer Risk:
http://www.wdxcyber.com/ncanc05.htm

Urethral Dilatations for Recurrent UTIs - Are They Helpful?
http://www.wdxcyber.com/nurine09.htm

Intestinal Surgery:
http://www.clevelandclinic.org/misc/...intestinal.htm
http://www.acg.gi.org/acghome.html

list of colorectal surgeons in your area:
http://www.fascrs.org/directory/directory.html

What does it mean to be a Board Certified Colon and Rectal Surgeon?
http://www.fascrs.org/brochures/abcrs-surgeon.html

http://www.scuba-doc.com/giprbs.html
http://www.gihealth.com/html/test/po...tructions.html

"The Pain-Less" Hysterectomy:
http://www.obgyn.net/women/articles/...anter_0512.htm

Small bowel resection:
http://www.clevelandclinic.org/misc/...ctal/small.htm
http://www.besthealth.com/surgery/Sm...section_1.html

Bowel Resection procedure handout:
http://library.med.nyu.edu/HCC/hando...oced/bowel.pdf

Vaginal Vault Prolapse:
http://www.urogynecologychannel.com/prolapse5.shtml

Good Luck in your research & desicion I hope you are able to find some relief to your problems soon..Pls keep us posted...(((((((hugs)))))))
  #6  
Unread 03-08-2003, 10:36 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

Thank you everyone! I had a sledding accident pre-school and was treated for 6 months w/sulfa drugs until my dad took me to a DO who said I had a tipped pelvis. Some manipulation and the pain was gone but did continue to wet the bed until 8 yo at which time another DO said my pelvis was still somewhat tipped and did some more manipulation and I quit wetting the bed.

However, urinary frequency and sometimes urgency continued until I had a tubal ligation when I was 31. They also did a bladder and a uterine suspension and, against my objections, an appendectomy. They wouldn't agree to the tubal ligation unless I agreed to the appendectomy so I finally gave in on the appendectomy. I have to say that bladder suspension was WONDERFUL! For the first and only time in my life I found out how long "normal" women can hold their urine and how much urine a "normal" bladder can hold. However, I've always done a lot of heavy work, lifting, etc. and eventually the urinary frequency returned.

I can live with it, obviously, but that while after the suspension sure was nice! I see advice about being sure that a uro is present during your hysterectomy and so much information about possible nicking or injuring of the bladder and/or ureters during a hysterectomy that it really does concern me.

I've also seen information that the cervix serves to help prevent prolapse after a hysterectomy. Sheri, thank you so much for all the URLs. I will check each and everyone of them out thoroughly.

Cmcm: I've only had one appt with a uro. Just had the IVP w/normal results. A cystoscopy is scheduled for 20 Mar. I'm not particularly enamored of this uro after one visit. Neither one of us got off on our best foot. In fact, I'm ticked off enough I am seriously considering just not keeping the cystoscopy appt w/o notifying him or his office, just not showing up. The "only" reason I am somewhat undecided is because I have a good relationship and a lot of respect for my GP who referred me to him and I don't know any uros, nor do I even know if there are any uro/gyns or uro/oncos in our area. Besides which I LIKE my gyn real well. Didn't care much for the gyn/onco I was referred to. I've just always relied on a good GP and frankly, the urinary frequency has been a part of my life for so long, since a little kid, that only 3 times have I ever gone to a doctor complaining about it. All three times the urine culture was clear despite UTI symptoms. Go figure. However, what occasioned the referral to the uro was that I ended up in ER w/extreme UTI symptoms on Super Bowl Sunday. 3 bags of IVs, IV Cipro and sent home w/oral Cipro. Symptoms have lessened on their own since then, can't say that the Cipro did much of anything. At least no more pain, just an occasional pang in the flank and dull aches or bruised feeling in the back lower ribs. Surprisingly, after the 2 day liquid diet and the IVP I'm having less urinary frequency than at any time in my life except the while after the suspension! Go figure. I'm not complaining!!!!

Thanks, Locki, for the info re: estrogen levels & urinary frequency. I had read some about that too. Since I'm 10 years post menopause I question whether estrogen has much to do with my situation. On the other hand, some say the ovaries continue to contribute some hormones past menopause ... my gyn says no, not this late. But he's a man, much as I like him, what do men know?? Wicked grin. The right ovary is tiny and apparently healthy and I've given some thought to keeping the little devil if I do have the hysterectomy. There's no history of any kind of cancer on either side of my family .... but I'll probably agree to part with it given my age, so many years past menopause and the difficulties of discovering ovarian cancer early on.

Thank you again, each of you. I so appreciat your sharing your experiences, your advice and the URLs. I hope others join us with their thoughts and experiences. And I sure do wish each and everyone of you the best!

P.S. In case you haven't guessed: I don't particularly have faith in ANY surgeon! I don't like anesthesia. "I" want to know what is going on and have some say in the final decisions, many of which can't be made until they get in there and see the actual situation. So I"m thinking of an epidural w/no general anesthesia.
  #7  
Unread 03-08-2003, 10:40 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

Wonder if they would put a mirror above the operating table and give me a pair of binoculars so I could see real good??

Wicked grin.
  #8  
Unread 03-08-2003, 11:17 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

  Quote:
Wonder if they would put a mirror above the operating table and give me a pair of binoculars so I could see real good??

There are many ((Sisters)) here who have had the general done..you can use the *search* function at the top to find other's who've had this. Here is some more info too on this method:

Continuous spinal technique:
http://www.esraeurope.org/abstracts/...s98/rosen1.htm

Spinal Anaesthesia - a Practical Guide:
http://www.nda.ox.ac.uk/wfsa/html/u12/u1208_06.htm#comp
http://www.nda.ox.ac.uk/wfsa/html/u12/u1208_01.htm

Regional vs spinal:
http://www.unc.edu/~rvp/CVDocs/Regional%20Anes%20(Anes%20401).htm

Surgery Interest Group - Spinal Blocks:
http://www.amsa.org/surg/anessb.cfm

Anesthesia Patient Safety:
http://www.anesthesiapatientsafety.c...lance/nnaw.asp

The Ovaries will continue to dribble out small amount of Hormones even after Menopause..these are easier to compensate what is lost than to totally replace. Here is some on the Ovaries:

Should I Keep My Ovaries?
http://drn4u.com/keepovaries.htm

Hysterectomy-Leave the Ovaries-Gabe Mirkin, M.D.
http://www.drmirkin.com/women/W126.htm

Hormonetesting.net-Dr. Daniel Bivins: http://www.hormonetesting.net/

Talking To Your Doctor About HRT:
http://www.aeron.com/new_page_21.htm

Menopause Symptoms and Hormone Replacement Therapy: http://www.menopause-and-osteoporosis.com/

  Quote:
Problems of ovary removal:
If the ovaries are removed, the woman goes into surgically induced menopause, as the hormone producing organ has been taken out. As a result, she may have problems of flushes and vaginal dryness.

These are particularly troublesome when the woman in question is in her twenties or thirties or, worse still, in her teens. The removal of the ovaries and the subsequent loss of hormones could result in bones becoming weaker and an increased risk of heart disease.

Women who are less than forty may go in for hormone replacement therapies wherein hormones are artificially introduced to make up for the hormones lost by removing the ovaries. Not all women tolerate this artificial hormone replacement and the risk of breast and gall bladder cancer increases. As far as possible, doctors try to retain at least one ovary so that natural hormone production isn’t badly affected.

http://channels.apollolife.com/show.asp?NewAid=4107
the role of ovarian hormones upon brain:
http://www.bbsonline.org/Preprints/O...bbs.fitch.html

Old Ovaries-still of value?
https://www.hystersisters.com/vb2/sho...threadid=10987

BSO:
http://www.gyndr.com/salpingo-oophorectomy.htm


  Quote:
A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome.
Speroff T, Dawson NV, Speroff L, Haber RJ

Department of Epistemology and Biostatistics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio.

A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporosis fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed.

Am J Surg 1997 Jun;173(6):495-498

Is incidental prophylactic oophorectomy an acceptable means to reduce the incidence of ovarian cancer?

Rozario D, Brown I, Fung MF, Temple L

Department of Surgery, Ottawa General Hospital, University of Ottawa, Ontario, Canada.

BACKGROUND: According to previous reports, the lifetime risk of developing ovarian carcinoma is 1.4%. This figure varies with age from 6.6 per 100,000 among women aged 35 to 39 years up to 55.1 per 100,000 among women aged 75 to 79 years. Prophylactic oophorectomy remains a modality to decrease the incidence of ovarian cancer. What proportion of women diagnosed with an ovarian malignancy had a preceding laparotomy at which time a prophylactic oophorectomy could have been performed?

METHODS: We reviewed the new ovarian cancer diagnoses seen in patients between August 1988 and August 1993 at the Ottawa Regional Cancer Foundation. Four hundred and four patients were identified. These patients were analyzed for preceding abdominal surgery, age, time to disease progression, time to death, time to death from other causes, and average follow-up. The previous abdominal surgeries were divided into: (1) major gynecological surgery; and (2) general surgery procedures, which were further divided into laparotomy and pelvic surgery (group A surgeries) and general surgery that included other abdominal surgeries (ie, appendectomy, cholecystectomy) where access to the pelvis could be more difficult (group B surgeries).

RESULTS: A total of 270 abdominal surgeries was performed, prior to the diagnosis of ovarian cancer. The group was stratified according to the timing of the surgery ( greater or =40 years, 41 to 45 years, 46 to 50 years, >50 years). Based on these data, and on the grouping of general gynecologic surgeries plus the general surgical procedures of group A, 10.9% of ovarian cancers would have been prevented if prophylactic oophorectomy had been performed in patients who had surgery over 40 years of age; over 45 years this was 6.7%, over 50 years it was 4%. If one adds all major surgeries, including general surgery groups A and B, the results were 26.9% over 40 years of age, 20% over 45, and 16.6% over 50.

CONCLUSION: We found that, depending on the age of the patient, prophylactic oophorectomy results in a 4% to 10.9% reduction in the incidence of ovarian carcinoma. This increases to 16.6% to 26.9% if one considers general surgery procedures in which access could be more difficult. Although we are not advocating the frequent use of this procedure, we recommend that surgeons routinely discuss this option before surgery with their postmenopausal female patients over 49 years of age. Given that the decision for prophylactic oophorectomy is multifaceted, we feel that a risk scoring for ovarian cancer and a discussion of the risk and benefit ratio should be undertaken. The ultimate goal is to heighten patient awareness of the risk factors to ensure that an informed decision is made concerning this consistently lethal disease.
((((hugs))))
  #9  
Unread 03-08-2003, 11:25 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

(((hugs))) to you yet again, Sheri, for these wonderful URLs. The two lists, this one and the earlier one, certainly ought to keep me out of mischief for a good while!

But what about my odds of the mirror and the binoculars if I decide to go ahead and to have the epidural w/o general anesthesia??? Big wide mischevous grin.
  #10  
Unread 03-09-2003, 06:12 AM
Hysterectomy w/cervic removal and uringary frequency or incontinence

Dear crohnietoo,

glad to read that your symptoms have improved somewhat following that treatment for the infection.

I guess if I were you, I would keep that appt with the urologist and have the cystoscopy done. Even if you don't like him, don't ever want him to operate on you, the test will provide valuable information and you will be in good standing with your GP still. Or at least, I'd cancel the appt appropriately and ask your GP for another referral.

Be sure to ask the surgeon about his particular incidence of bladder injuries. This is a matter of skill--my surgeon for instance has never nicked a bladder. That was reassuring to hear.

Since you already had a bladder suspension, I'm not sure what the other options are for you, although I have definitely read about women in this situation.

good luck sorting through all this...
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