الفهرس 
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Abstract
Introduction : Hysterectomy is the most common major gynaecological procedure done in the United Kingdom and the second most frequently performed major surgical operation in the developed world after caesarean section . The chance of a woman having a hysterectomy by the age of 55 has been estimated to be one in five. In the USA, more than 600,000 women have hysterectomies each year, making this the second most common major surgical procedure done, after caesarean section. By age of 60 years, about 40% of women in the USA have had a hysterectomy. The Aim of this study: This study aimed to compare between the effects of the laparoscopic, vaginal, and abdominal hysterectomy on the urinary, sexual function and quality of life by doing urodynamic study and analysing several questionnaires to these patients before and after one and six months after surgery for the different surgical routes of hysterectomy. Materials and methods : A prospective randomized study was designed to evaluate the effects of the three techniques of hysterectomy on urinary and sexual functions. It was interventional study for patients who underwent hysterectomy in the Gynecology Department, Mansoura university. All patients underwent urodynamic study on the Urology Center in Mansoura University A total of 122 Patients were eligible for inclusion. The study started with 85 patients who were allocated into three groups. At last 77 patients completed follow up schedule and were considered for final analysis Results: Our study was the first study that evaluated the impact of surgical approach on multiple aspects with addition of a validated questionnaire. To summarize, these investigations showed no significant differences between the effects of laparoscopic, vaginal, and abdominal hysterectomy on the mechanics and functions of the bladder wall. We have not found any negative effects on bladder function 4 weeks and 6 months after operation. The impact of hysterectomy for benign disease on subsequent sexual function is influenced by the route of surgery, whether abdominal, vaginal, or laparoscopic. Improvement of some measures of sexual function after surgery represents a probable outcome as regard to the surgical technique used. Our study revealed that hysterectomy has slight negative effect on the sexual functions with the least effect noted in the vaginal group. Finally, vaginal hysterectomy is superior to abdominal and laparoscopic hysterectomy regarding operative time, hospital stay, incidence of complications, time to recover, patient satisfaction and quality of life. Urodynamic measurement between all groups was comparable on pre- and post-operative state apart from significant decrease of bladder capacity in the abdominal group (p<.001) and decrease pressure of the detrusor Ms at Qmax. To conclude, whenever possible in selected cases, vaginal hysterectomy may be a preferred approach for hysterectomy as it carries the advantage of lesser operative time, it is associated with less hospital stay and postoperative pain with quicker recovery and more patient satisfaction over the other techniques. Laparoscopic surgery was introduced to decrease abdominal hysterectomy, and not to replace vaginal hysterectomy. Total laparoscopic hysterectomy is comparable to vaginal hysterectomy in terms of postoperative parameters and satisfaction, but it has a significantly longer operative time, longer time to recover, hospital stay and requires laparoscopic surgery skills.