Urodynamic Changes Following Laparoscopic Versus Vaginal Hysterectomy: A Hospital based Comparative Cross-Sectional Study
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Abstract
Background: The choice of surgical approach for hysterectomy can influence several postoperative outcomes, particularly urodynamic parameters.
Objectives: To determine the urodynamic changes (using cystometric and uroflowmetric parameters) before and after vaginal and laparoscopic hysterectomy.
Methods: This was a hospital based comparative cross-sectional study conducted by the Department of Urology in the outpatient department and/or inpatient wards of the Department of Obstetrics and Gynaecology, in a tertiary teaching healthcare facility located in South India between January 2023 and June 2024.
Results: The baseline characteristics (age, weight, and parity) of the patients in the study groups (Group I, vaginal hysterectomy and Group 2, laparoscopic hysterectomy) did not vary significantly. Postoperative urination frequency was significantly higher in the vaginal group (40%) compared to the laparoscopic group (20%). However, urgency (21.7% vs. 13.3%) and urge incontinence (20% vs. 13.3%) were not significantly different between the groups. Preoperative and postoperative ICIQ-FLUTS scores increased significantly within both groups, but the differences between groups were not significant. Cystometry showed that the mean volume at first sensation increased postoperatively in both groups, with significant increases within each group but no significant difference between groups. Cystometric bladder capacity decreased postoperatively, significantly within each group, but not between groups. Postoperative detrusor muscle overactivity was significantly higher in the laparoscopic group (93.3%) compared to the vaginal group (80%). Uroflowmetry parameters revealed no significant differences in preoperative or postoperative voided volume and maximum flow rate between groups. Voiding time increased significantly postoperatively in the vaginal group but not in the laparoscopic group. The average flow rate decreased significantly in the vaginal group and increased significantly in the laparoscopic group. Residual urine volume increased significantly postoperatively in the vaginal group but not in the laparoscopic group.
Conclusion: The results showed significant differences within each group, particularly in urination frequency, detrusor muscle overactivity, voiding time, average flow rate, and residual urine volume.