INDICATIONS FOR HYSTERECTOMY

The knowledge needed to formulate proper indications for hysterectomy include a thorough understanding of the physiology and pathology of the female reproductive organs, the clinical manifestations of pelvic disease, and normal and abnormal psycho/social/sexual development. This basic and thorough knowledge and understanding is the absolute foundation on which to base the practice of gynecologic surgery. After the right operation has been selected for operation, the right operation must be selected for the patient. The successful practice of gynecologic surgery also requires proper preparation of the patient for the operation, proper performance of the operation, and proper postoperative care. A competent gynecologist who has followed a patient for several years, has kept careful records of findings and treatment, and has the patient's full confidence is most likely able to make the most accurate judgment about the necessity for hysterectomy. Yet, in most circumstances a 2nd opinion should still be sought. Apprpriate indications for hysterectomy include benign uterine disease and/or symptoms -- dysfunctional uterine bleeding; uterine pain, bleeding, and enlargement; uterine descensus and prolaspe; uterine leiomyomas; septic abortions; and obstetric catastrophs. Other indications include benign diseases of the tubes and ovaries in which the uterus is not primarily involved -- pelvic inflammatory disease, pelvic endometriosis, and ectopic pregnancy -- and neoplastic disease, namely, cervical intraepithelial carcinoma (carcinoma in situ), early invasive cervical cancer, endometrial adenocarcinoma and sarcoma, trophoblastic disease, ovarian and fallopian tube neoplasms, and malignant disease of other adjacent organs. Miscellaneous and usual indications for hysterectomy include cervical problems such as servical stenosis with recurring pyometra following unsuccessful attempts to keep the cervix open, chronic pelvic pain, pelvic congestion syndrome, and surgical sterilization. A partial list of inappropriate indications for hysterectomy includes prophylaxis against uterine cancer, contraception in a gynecologically normal patient, management of the menopause, leukorrhea and chronic cervictis, primary dysmenorrhea and premenstrual tension, mild urinary incontinence, postmenopausal bleeding, abnormal vaginal/cervical cytology, and cervical dysplasia.