Effects of genital prolapse surgery and hysterectomy on pelvic floor function

Abstract

This thesis aims to evaluate the effects of genital prolapse surgery and hysterectomy on pelvic floor function. A normal pelvic floor function is required to allow normal micturition, defecation, sexuality and vaginal delivery. Both vaginal delivery and surgical trauma to the pelvic floor can negatively affect pelvic floor function. Genital prolapse surgery and hysterectomy can both be performed by vaginal or by abdominal approach. It is unknown if, and to what extent, both techniques equally damage the pelvic floor innervation and pelvic fibromuscular structures. If there is a difference in surgical trauma, the prevalence of micturition symptoms, defecation symptoms and sexual dysfunction may differ among patients following vaginal and abdominal surgery. Micturition symptoms, defecation symptoms and sexual dysfunction are all signs of impaired pelvic floor function. These symptoms may negatively affect the patient’s quality of life. Gynecologists may be expected to attempt to reduce the negative influence of gynecological surgery on quality of life as much as possible. This can only be established by studying the effects of different types of genital prolapse surgery and hysterectomy on pelvic floor function. An additional aim of this thesis is to investigate diagnostic characteristics of defecography and ano-rectal function tests. Knowledge about these diagnostic characteristics may contribute in investigating whether defecography and ano-rectal function tests improve outcome of surgical correction in patients with descensus uteri. These investigations have not yet been incorporated in the standard diagnostic work-up of patients with genital prolapse. The diagnostic value of urodynamic investigation has already been assessed, and is therefore not subject to investigation in this thesis.