Preoperative Assessment of Candidacy for Vaginal Hysterectomy: A Clinical Study

Abstract

Objective: This study was conducted to evaluate the feasibility and ease of vaginal hysterectomy (VH) after performing an office examination and an examination under anesthesia (EUA). Materials and Methods: This was a prospective observational study of women who required simple hysterectomy. If the vaginal route was potentially feasible after office examination, EUA was performed, and the route proceeded accordingly. The data were analyzed to determine which preoperative factors were the best predictors of difficult VH. Results: There were 155 patients enrolled into this study. Office and EUA findings of a larger pelvis correlated with a “non-difficult” VH. Office and EUA findings of a platypelloid pelvis and large uterine size correlated with a “difficult” VH. Poor uterine mobility and global assessment at the time of EUA had the strongest correlation with a “difficult” VH. Position of the cervix above the ischial spines, both at rest and with traction, also correlated with a “difficult” VH. Multivariate analyses showed larger pelvic size found on office examination to be a significant predictor of a non-difficult VH; pelvic shape, uterine size, and mobility on EUA remained significant predictors of a “difficult” VH. Conclusions: EUA is more accurate than office examination for predicting the difficulty of VH and should be considered before deciding against the vaginal route. (J GYNECOL SURG 38:294)