Pelvic floor dysfunction in women after hysterectomy: from prevalence to treatment

This dissertation investigates pelvic floor dysfunction in women with a history of hysterectomy. A hysterectomy is considered a risk factor for pelvic organ prolapse, but long-term data has been lacking. In this dissertation, data from 247 women, approximately 16 years after hysterectomy, is presented. These women underwent gynaecologic examination in order to check the presence of prolapse and also completed questionnaires about pelvic floor symptoms. This dissertation shows the likelihood of prolapse after different types of hysterectomies and provides insights into the natural course of pelvic floor symptoms following a hysterectomy. Additionally, it offers insight into central sensitization syndrome in a urogynaecological population and its relationship with pelvic floor symptoms. The last two chapters focus on the treatment of vaginal vault prolapse (after a hysterectomy). It appears that there is significant practice variation in the Netherlands, and a new laparoscopic technique is emerging for the treatment of vaginal vault prolapse.