Background: Hysterectomy is the most common major obstetric gynecological operation.
Objective: To evaluate indications of hysterectomy.
Methods: Retrospective study of hysterectomies was performed in Kosar teaching hospital from 1995 till 1998, excluding cesarean hysterectomies.
Finding: Of 369 hysterectomies, 96 cases (26%) were vaginal and 273 (74%) were abdominal. Indication for all vaginal hysterectomies was uterine prolapse. The most common symptom in abdominal hysterectomies was vaginal bleeding. Final pathologic repol1s in order of prevalence included: myoma, normal, adenomyosis, glandular hyperplasia, polyp, simple hyperplasia, and cancer of endometrium. In almost half of the cases of TAH, preoperative indications were appropriate (49%). Of 51% of cases with inappropriate preoperative indications, 26% had pathology in uterus (e.g adenomyosis), and the remaining 25% had no organic lesion in final pathologic report. Positive and negative predictive values of clinical diagnoses were 0.75 ± 0.04 and 0.49 ± 0.05 respectively, (P= 0.05).
Conclusion: To prevent unnecessary hysterectomy, accurate preoperative evaluation, understanding of gynecologic pathology and knowledge of new alternative medical and surgical modalities are essential.