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Stang et al have provided an important impulse for further discussion with their much-welcomed article on hysterectomy in Germany. All crucial statements in the article relate to hysterectomy undertaken for benign indications. The data on hysterectomy given in the first sentences of the results and discussion sections are contradictory: the hysterectomy rate in benign diseases of the female genital organs in Germany was not 3.6 per 1000 person-years; this is obviously the total hysterectomy rate for the whole of Germany. A more detailed explanation of the hysterectomy rate per 100 000 person-years, which was mentioned several times, would have been desirable. One critical comment: the authors obviously used the entire female population on their selected date of 2005 in their calculations. However, it does seem sensible to exclude at least girls younger than 10 years and women older than 80 years. The statement relating to the use of MRI-guided focused ultrasonographic ablation and uterine artery embolization for women wishing to keep their uterus requires a correction: these treatments for fibroids have been routinely used for many years. An alternative to hysterectomy in menorrhagia is hysteroscopy, a minimally invasive procedure, which was not mentioned in the discussion section (2).

The hysterectomy rate, but also the way in which hysterectomies are performed in benign indications, gives a clue about the respective surgeon’s school of thought, the apparatus and other options available in the respective hospital, and flows—sometimes extending beyond state boundaries.

A self-critical look at the hysterectomy rate in Germany on the part of the gynecological community is urgently required. This relates to defining indications in case of benign disease, the surgical modus operandi, and the question of whether the cervix should be spared. In conclusion, a large, nationwide, prospective health services research study is more than overdue in Germany.

DOI: 10.3238/arztebl.2012.0158b

Prof. Dr. med. Matthias David

Charité – Universitätsmedizin Berlin

Campus Virchow-Klinikum

matthias.david@charite.de

Prof. Dr. med. Heribert Kentenich

Fertility Center Berlin

Conflict of interest statement
The authors declare that no conflict of interest exists.

1.
Stang A, Merrill RM, Kuss O: Hysterectomy in Germany: a DRG-based nationwide analysis, 2005–2006. Dtsch Arztebl Int 2011; 108(30): 508–14. VOLLTEXT
2.
Stovall DW: Alternatives to hysterectomy: focus on global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound. Menopause 2011; 18: 443–50.
MEDLINE
1.Stang A, Merrill RM, Kuss O: Hysterectomy in Germany: a DRG-based nationwide analysis, 2005–2006. Dtsch Arztebl Int 2011; 108(30): 508–14. VOLLTEXT
2. Stovall DW: Alternatives to hysterectomy: focus on global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound. Menopause 2011; 18: 443–50.
MEDLINE