Should I Go For Vaginal Or Abdominal Hysterectomy? What Are The Findings From Transvaginal Exam?

Posted on Wed, 11 Dec 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 11 Dec 2013 Answered on

Mon, 30 Dec 2013 Last reviewed on

Question : I am 48 yrs old and ready for a hysterectomy due to ever increasing length and pain of periods. Main question I guess is abdominal or vaginal. I have one child and don't want any more. Gyn appt is not scheduled for another month and half. Here are the results of my ultrasound and transvaginal exam. Uterus measures 11.2 x 6.5 x 8.8 cm. Numerous hypoechoic/heterogeneous myometrial masses are seen compatible w/fibroids. Largest fibroid noted along left mid uterus 3.9 x 3.9 x 4.0 cm in. Endometrial lining largely obscured due to numerous fibroids. No definite endometrial thickening is sonographically evident. Right ovary measures 2.2 x 0.9 x 1.0 cm. Left ovary measures 1.9 x 0.9 x 1.7 cm. Nabothian cysts are seen in the cervix. No free fluid is evident in the pelvic cul-de-sac

Answered by Dr. Dr. ARIF N K (12 minutes later)

Brief Answer: Vaginal route is best Detailed Answer: Hi, Thank you for choosing XXXXXXX I have analyzed your scan report. Route of surgery in your case depends on few below mentioned things: 1)Previous child birth, if vaginal or caesarean? 2)On per speculum examination what is the descent of cervix up to? If there is descent then vaginal hysterectomy can be planned. In your case if the previous birth is vaginal (which you have not mentioned) and if there is good amount of descent, if I was your treating surgeon I would have gone for VAGINAL HYSTERECTOMY. As vaginal surgery is always best in terms of pain, morbidity, hospital stay, infection rate..etc. Also considering your age it is very important to conserve the ovaries. Please ask if you have more questions. If you are satisfied, please make sure that your ACCEPT my answer so that I receive credit. Good luck!!

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. ARIF N K (9 minutes later)

I have had one child (22) delivered vaginally, no problems. No mention of descent of cervix.

Answered by Dr. Dr. ARIF N K (4 minutes later)

Brief Answer: descent is checked clinically Detailed Answer: Hi, Thank you for choosing XXXXXXX So its good that your child is delivered vaginally, secondly the descent of cervix is to be checked clinically by your treating surgeon by putting a speculum and pulling the cervix and see how much is the descent. Hope you are cleared of your doubt. So if there is good descent then definitely you are a good candidate for vaginal hysterectomy. One more thing, if you are not an obese person that will be an added advantage. Please ask if you have more questions. If you are satisfied, please make sure that your ACCEPT my answer so that I receive credit. Good luck!!

Above answer was peer-reviewed by : Dr. Yogesh D