Algorithm for preoperative examination of the cervical status in patients with hyperplastic processes of the endometrium and myometrium to determine the extent of hysterectomy and postoperative follow-up

Objective: to develop an algorithm for perioperative management of patients with endometrial and myometrial hyperplastic processes for the prevention of cervical disease.

Material and methods: a cross-sectional comparative study was conducted in 100 women 3–5 years after subtotal hysterectomy. Two groups were formed: Group I (n=50) - patients after supravaginal hysterectomy without oophorectomy; Group II (n=50) - with oophorectomy. The examination protocol included gynecological examination, extended colposcopy, cytological assessment (conventional and liquid-based), microbiological testing, and PCR detection of human papillomavirus (HPV). The findings served as the basis for algorithm development.

Results: in the long-term follow-up period, patients in both groups showed a persistently high rate of complaints of pathological discharge (48–50%) and gynecological conditions such as cervicitis and colpitis. No statistically significant differences in the incidence of cervical stump pathology were found between the group with preserved ovaries and the group after oophorectomy (p>0.05). Liquid-based cytology demonstrated a 1.4-fold higher detection rate of pathological changes compared with the conventional Pap smear. Based on the data obtained, a 4-stage perioperative management algorithm was developed.

Conclusion: the proposed algorithm, based on comprehensive preoperative cervical evaluation and mandatory postoperative surveillance, enables a personalized approach to the selection of hysterectomy extent. It allows safe performance of organ-sparing subtotal hysterectomy in low-risk patients and ensures timely detection of cervical stump pathology in the long-term follow-up period.

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