ABSTRACT
OBJECTIVE: To determine whether women know their own cervical cancer screening recommendations after hysterectomy, and to evaluate patients' understanding of hysterectomy terminology and cervical cancer screening. METHODS: A 19-item questionnaire was developed and administered to 413 women who had undergone minimally invasive hysterectomy with benign pathology between January 2008 and January 2012. RESULTS: A total of 190 women (46%) participated in the survey. The majority of respondents were Caucasian (61%) and had a college education (66%). Fifty-nine percent of respondents knew that a Pap test screens for cervical cancer, and 40% knew that HPV is related to cervical cancer. Eight-four percent understood that Pap screening is recommended if a woman still has a cervix after hysterectomy. Only 67% correctly identified if their cervix had been removed during their own surgery and if they needed future cervical cancer screening per current guidelines. Caucasian race and higher income were significant predictors of hysterectomy and screening knowledge. CONCLUSION: Knowledge regarding Pap tests, HPV, and implications of a supracervical hysterectomy is lacking, even among a post-hysterectomy population. PRACTICAL IMPLICATIONS: Patient educational information is needed to improve perioperative counseling regarding the type of hysterectomy performed and indications for future cervical cancer screening.
Subject(s)
Health Knowledge, Attitudes, Practice , Hysterectomy , Papanicolaou Test , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , Vaginal Smears/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Early Detection of Cancer , Female , Guideline Adherence , Humans , Middle Aged , Practice Guidelines as Topic , Socioeconomic Factors , Surveys and Questionnaires , Uterine Cervical Neoplasms/virologyABSTRACT
OBJECTIVE: Recurrence of pelvic organ prolapse (POP) is a potential complication after mesh removal. We evaluated anatomical and functional outcomes preoperatively and postoperatively in patients undergoing mesh excision. MATERIALS AND METHODS: We conducted a retrospective cohort analysis of consecutive patients who underwent mesh excision from years 2005 to 2009. Anatomical outcomes were evaluated using the POP quantification (POP-Q) system. Recurrence of prolapse was defined as stage II or higher-stage prolapse on the POP-Q system, reoperation for prolapse, or postoperative use of a pessary for prolapse reduction. Functional outcomes were assessed using the pelvic floor distress inventory and pelvic floor impact questionnaire scores. RESULTS: Data were analyzed from 71 patients who underwent either partial or complete mesh excision. Most (44/70 [63%]) of the patients underwent partial mesh excision, and 26 patients (37%) underwent total mesh removal. Nineteen patients (26.7%) had preoperative prolapse and 27 (38.0%) of the 71 patients underwent concomitant native tissue prolapse repair. Overall change in POP-Q stage in women who underwent partial removal (median, 0 [-1 to 2]) was less advanced than in women with total excision. (median, -1 [-3 to 0]; P = 0.006) at 1 year postoperatively. Four patients prolapsed to the hymen, with all patients having defects in the anterior compartment. No patients required a second surgery, and one patient was treated with a pessary.Total pelvic floor distress inventory and pelvic floor impact questionnaire scores before mesh excision were significantly improved 6 months after mesh removal (P < 0.05). Dyspareunia improved significantly after mesh excision (P = 0.034). CONCLUSION: In our patient population, total and partial mesh excision is associated with re-treatment of POP in 1.4% of the patients. Patient functional outcomes significantly improved after mesh removal.
