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    "datePublished": "2009-03-18", 
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    "description": "SubjectHysterectomy is the second most frequent operation performed on the abdomino-pelvic area in France, after Caesarean section. There are three approaches to hysterectomy for benign disease \u2014 abdominal hysterectomy (AH), vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). Complications and patient outcomes in the short term have already been described. The purpose of this article is to analyse the risk of urological, colorectal and sexual sequelae after hysterectomy at medium and long term follow up.MethodsThis review is based on data from the Cochrane Database and Medline. The key words used were hysterectomy, urinary incontinence, constipation, dyspareunia, and sequelae. The period covered is from 1985 to 2008. In this analysis, risk of prolapse secondary to hysterectomy, and hysterectomy for malignant disease are not taken into account (10% of hysterectomies).ResultsUrological sequelae exist and it seems that hysterectomy presents a substantial risk of urinary incontinence at long term. Regarding anorectal sequelae, data from the literature are contradictory and sequelae are probably minimal. Concerning genito-sexual consequences, association with bilateral oophorectomy in non-menopausal patients can lead to difficulties in adjusting to the hormonal deficiency, as at the start of menopause. The surgical approach chosen for hysterectomy for benign gynaecological disease might have a psychosexual impact: VH and LH should be preferred. There is no value in retaining the cervix.ConclusionsHysterectomy, whatever the surgical approach chosen, leads to a risk of urinary and psychosexual sequelae at long term follow up, at the very least. VH and LH are preferred to laparotomy. There is no value in retaining the cervix. A new debate is open on uterus preservation in young women undergoing pelvic organ prolapse surgery. However, further research is required with full reporting of all relevant outcomes, particularly significant long-term outcomes, in large randomised trials, to minimise any possibility of reporting bias. Further research is also required to define the role of the newer approaches to hysterectomy such as Total Laparoscopic Hysterectomy.", 
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    "name": "S\u00e9quelles v\u00e9sicosphinct\u00e9riennes, anorectales et g\u00e9nitosexuelles de l\u2019hyst\u00e9rectomie", 
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