Changes in ovarian volume, function and vascularity following hysterectomy

الملخص EN

Objective : to study changes and data representative of clinical findings and findings present at transvaginal sonography (TVS) of the volume and functions of the ovaries preserved at the time of hysterectomy as well as changes in the ovarian vascularity detected by color Doppler studies as this may help solving the dilemma of whether to remove or preserve the ovaries at the time of hysterectomy.

Study design : A clinical prospective observational study carried out at Al-Azhar University Hospitals and Kuwait Maternity Hospital, between December 2006 and October 2008.

Patients and methods : Sixty patients scheduled for hysterectomy for benign indications were included.

The following patients were excluded out of the study : patients with apparent menopausal symptoms, suspicious genital malignancy, grossly abnormal ovaries or previous ovarian or tubal surgery (e.g.

tubal ligation, salpingectomy and ovarian drilling, cystectomy, wedge resection).

Patients were subjected to history taking, clinical examination and routine preoperative laboratory investigations.

TVS and color Doppler studies were done preoperatively as well as one month, six months and one year postoperatively to assess the following : clinical follow up of the patient regarding development of menopausal symptoms, Ovarian volume which is the result of multiplying the 3 dimensions of the ovary, multiplied then by 0.5.

i.e.

0.5233 x Dl (length) x D2 (width) x D3 (breadth) (cc), Development of ovarian follicles, Resistance index (RI) of the ovarian arteries.

RI = S-D / S, where S = peak systolic flow, while D = end diastolic flow.

Results : there was a significant decrease in the ovarian volume at 6-month and one-year follow-up visits (from 8.71 ± 1.04 to 6.39 ± 0.93 and 5.82 ± 0.84cc, respectively, P < 0.001).

It was found that the resistance index (RI) of the ovarian arteries had significantly increased at 6-month and one-year follow-up visits when compared to the preoperative values (from 0.49 ± 0.03 to 0.55 ± 0.07 and 0.58 ± 0.08, respectively, P < 0.0bl).

The rate of decrease in the ovarian volume was found less pronounced in the older group compared to the younger groups (P < 0.001).

Whereas the increase in RI was considered less pronounced in the middle group (40-44yr) than in the other 2 groups (P < 0.05).

Conclusion : the results of this study indicate the even with preservation of ovaries, patients will develop substantial disturbances in ovarian volume and its blood supply at 6-month follow-up visit.

The principle of prophylactic oophorectomy at the time of hysterectomy specially with increasing age towards menopause is highly appreciated and should be considered as the ovarian function is compromised.