Urinary Problems & LAVH
Frederick R. Jelovsek MD
Laparoscopic vaginal assisted hysterectomy (LAVH) is a popular form of hysterectomy when it can replace the need for an abdominal hysterectomy with a procedure that offers much faster recovery. Recovery from a vaginal hysterectomy is 2-4 weeks while that from an abdominal procedure is 4-6 weeks. If all else is equal (costs, risks) then LAVH should replace many of the abdominal procedures.
Unfortunately LAVH takes longer than an abdominal hysterectomy and thus the costs as far as operating room and anesthesia time are greater. Most patients don't have to directly pay these increased costs because their insurers do. Physicians are sometimes hesitant to perform more expensive procedures because insurers keep track of financial profiles for each physician and physicians who are more expensive run the risk of not having contracts renewed.
Risks To Urinary Tract
Some risks seem to be higher with LAVH. Injuries to the urinary tract including the bladder and the ureter (tube connecting the kidney to the bladder) can happen with any hysterectomy. Recently a report, Tamussino KE, Lang PEJ, Breinl E: Ureteral complications with operative gynecologic laparoscop
y. Am J Obstet Gynecol 1998;178:967-70 from Austria discussed the rate of ureteral injury, a fairly serious complication usually requiring further surgery. Normally the rate of ureteral injury in abdominal hysterectomies is 1-2%. In this study, the injury rate was 4.3%. There have been other reports that show the same rates and some that show lower rates of injury. Most physicians agree that urinary tract injury is higher with LAVH.
The question remains as to whether the higher injury rate and cost of LAVH is high enough to affect its use or its frequency of recommendation. The important issue is for women to know the different risks involved so they can make more informed decisions.
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