Browsing by Author "Herath, R."

Now showing 1 - 17 of 17

An audit on perineal pain felt following childbirth: level of pain experienced and degree of analgesia used
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Jogarasah, K.; Herath, R.
BACKGROUND: Perineal pain is a common symptom following vaginal childbirth. Reducing of the degree of pain experienced has been shown to improve maternal wellbeing and normal functioning within the family. METHODS: We performed the audit in the professorial ward of the Colombo North Teaching Hospital. Participants perception of pain was assessed using a verbal numeric rating scale. RESULT: All participants had experienced some degree of perineal pain. However significantly reduced levels of pain were experienced in those who had received analgesia. CONCLUSION: Perineal pain is a common symptom among women following childbirth. However such pain can be significantly reduced with appropriate interventions
An audit on the completeness of partogramsin two obstetric units in two separate teaching hospitals in Sri Lanka
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Liyanapatabandi, D.; Bhabu, B.; Krishoban, B.; Wenurajith, B. K.; Karunasinghe, J.; Jayasinghe, K. S.; Jayawardena, G.R.M.U.G.P.; Herath, R.; Gunarathna, S.M.S.G.
INTRODUCTION: A systematic approach to labour is needed to make sure serious mistakes and variations are not made in management and cost effectiveness maintained. . We undertook an audit in two separate teaching hospital settings to assess thecompleteness of partogram maintenance in labour. METHODS: Retrospective analyses of partograms were done in non consecutive bed head tickets from January to April 2016. The research was conducted at Obstetric wards in the Colombo North Teaching Hospital and Colombo South Teaching Hospital. Annonymised data were entered into a database.RESULTS: A total of 72 and 81 bed head tickets were analysed in the two wards postnatal sections respectively. The completed partogram was available in 48 (66.7%) and 59 (72.8%) respectively with completeness of personal data as follows; name (100%, 97.5%), age (100%, 98.8%) parity (100%, 91.7%), bed head ticket (100%, 100%) and blood group (91.6%, 96.3%). Interpartum labour monitoring was documented as follows; fetal heart sounds (100%, 70.4%), contraction (37.5%, 43.2%), dilation (54.1%, 35.8%), alert and action lines (50%, 42%), descent (12.5%, 14.8%), liquor (50%, 66.7%), position (8.3%, 12.3%), caput (12.5%, 8.6%), and molding (8.3%, 4.9%). CONCLUSIONS: Both maternal and labour parameters show high levels of incompleteness which destroys the true use of a partogram which is early identification and prompt intervention in the instance of maternal or labour complications.
Challenges of costing a surgical procedure in a lower-middle-income country
(Springer-Verlag, 2019) Ekanayake, C.; Pathmeswaran, A.; Kularatna, S.; Herath, R.; Wijesinghe, P.
BACKGROUND: It is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower-middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHODS: A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities. RESULTS: The total cost [(interquartile range), number] of TAH was USD 339 [(308-397), n = 24] versus USD 338 [(312-422), n = 25], NDVH was USD 315 [(316-541), n = 23] versus USD 357 [(282-739), n = 26] and TLH was USD 393 [(338-446), n = 24] versus USD 429 [(390-504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy. CONCLUSIONS: The costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings.
Comparison of metformin versus other treatment modalities in gestational diabetes mellitus
(Society for Advance Healthcare Research, Maharashtra, India, 2016) Ekanayake, C.D.; Wijesinghe, P.S.; Herath, R.; Puliyadda, N.; Nishad, N.
INTRODUCTION: Despite evidence to prove both its efficacy and safety, use of metformin is at most restricted to only as an adjunct to insulin preparations. We compared the maternal, fetal and neonatal outcomes associated with GDM in women treated with metformin versus those treated with diet alone and diet plus insulin. Method: An observational study was carried out over a period of six months in 104 GDM patients. Study groups were 43 patients on diet alone (group A), 42 on metformin plus diet (group B), and 19 on diet plus insulin (group C). Maternal, fetal and neonatal outcomes were compared. Results: Fourteen patients in group B subsequently required supplemental insulin. Gestational hypertension 5(12%), 4(10%), 5(26%) (p=0.8) and wound infection among 2(5%), 1(2%), 0(0%) (p=0.6) were seen in groups A, B and C respectively. Four patients with polyhydramnios were seen in group B. Mean birth weights were A=3.07kg, B=3.07kg, C=3.1kg (p=0.96). Macrosomia 5 (12%), 3 (7%), 3 (16%) (p=0.2), neonatal hypoglycemia 2 (5%), 2 (5%), 2 (11%) (p=0.4), five minute Apgar scores 9.9, 9.7, 9.9, and neonatal jaundice 5(12%), 4(10%), 3(16%) (p=0.04) were noted in in groups A, B and C respectively. Single case of respiratory distress was seen in the insulin group. Shoulder dystocia and perinatal deaths were not observed. Conclusion: Maternal and perinatal outcomes were similar among diet alone, diet plus metformin, and diet plus insulin groups. Cost-effectiveness, easy administration, safety profile and convenience of storage would make metformin an attractive option in the management of gestational diabetes mellitus.
Cost evaluation, quality of life and pelvic organ function of three approaches to hysterectomy for benign uterine conditions: study protocol for a randomized controlled trial
(BioMed Central, 2017) Ekanayake, C.; Pathmeswaran, A.; Kularatna, S.; Herath, R.; Wijesinghe, P.
BACKGROUND: Hysterectomy is the commonest major gynaecological surgery. Although there are many approaches to hysterectomy, which depend on clinical criteria, certain patients may be eligible to be operated in any of the several available approaches. However, most comparative studies on hysterectomy are between two approaches. There is also a relative absence of data on long-term outcomes on quality of life and pelvic organ function. There is no single study which has considered quality of life, pelvic organ function and cost-effectiveness for the three main types of hysterectomy. Therefore, the objective of this study is to provide evidence on the optimal route of hysterectomy in terms of cost-effectiveness by way of a three-armed randomized control study between non-descent vaginal hysterectomy, total laparoscopic hysterectomy and total abdominal hysterectomy. METHODS: A multicentre three-armed randomized control trial is being conducted at the professorial gynaecology unit of the North Colombo Teaching Hospital, Ragama, Sri Lanka and gynaecology unit of the District General Hospital, Mannar, Sri Lanka. The study population is women needing hysterectomy for non-malignant uterine causes. Patients with a uterus > 14 weeks, previous pelvic surgery, those requiring incontinence surgery or pelvic floor surgery, any medical illness which caution/contraindicate laparoscopic surgery and who cannot read and write will be excluded. The main exposure variable is non-descent vaginal hysterectomy and total laparoscopic hysterectomy. The control group will be patients undergoing total abdominal hysterectomy. The primary outcome is time to recover following surgery, which is the earliest time to resume all of the usual activities done prior to surgery. In total, 147 patients (49 per arm) are needed to have 80% power at α-0.01 considering a loss to follow-up of 20% to detect a 7-day difference between the three routes; TLH versus TAH versus NDVH. The economic evaluation will take a societal perspective and will include direct costs in relation to allocation of healthcare resources and indirect costs which are borne by the patient. A micro-costing approach will be adopted to calculate direct costs from the time of presentation to the gynaecology clinic up to 6 months after surgery. Incremental cost-effectiveness ratios (ICER) will be obtained by calculating the incremental costs divided by the incremental effects (time to recover and QALYs gained) for the intervention groups (NDVH and TLH) over the standard care (TAH) group. DISCUSSION: The cost of the procedure, quality of life and pelvic organ function following the three main routes of hysterectomy are important to clinicians and healthcare providers, both in developed and developing countries.
A Fatal case of dissecting aortic root aneurysm due to undiagnosed Marfan syndrome in the puerperium
(Sri Lanka College of Obstetricians and Gynaecologists, 2012) Nishad, A.A.N.; Herath, R.; Silva, G.R.C.; Mohamed, R.; Wijesinghe, P.; Padumadasa, S.; Premawardhena, A.; Premaratna, R.
Aortic dissection in pregnancy is a lethal cardiovascular complication in women with Marfan syndrome. The course of the treatment would be decided upon by the size of aortic root dilation. We report a case where the unawareness of the diagnosis of Marfan syndrome antenatally led to disastrous post partum consequences even after an uneventful childbirth.
Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women—A community based retrospective cohort study
(PLOS ONE, 2017, DOI: 10.1371/journal.pone.0179647 /http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0179647&type=printable, 2017) Herath, H.; Herath, R.; Wickremasinghe, R.
Background Women with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life compared to women with no GDM. This study was aimed to determine the risk of developing T2DM 10 years after GDM in Sri Lankan women. Methods A retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 women who delivered a child in 2005 were identified through Public Health Midwives in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. One hundred and nineteen women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on history, relevant medical records and blood reports within the past 1 year. Results The mean duration of follow up was 10.9 (SD = 0.35) years in the GDM group and 10.8 (SD = 0.31) years in the non-GDM group. The incidence density of diabetes in the GDM group was 56.3 per 1000 person years compared to 5.4 per 1000 person years in non GDM group giving a rate ratio of 10.42 (95% CI: 6.01–19.12). A woman having GDM in the index pregnancy was 10.6 times more likely to develop diabetes within 10 years compared to women with no GDM after controlling for other confounding variables. Delivering a child after 30 years, being treated with insulin during the pregnancy and delivering a baby weighing more than 3.5 Kg were significant predictors of development of T2DM after controlling for family history of diabetes mellitus (DM), GDM in previous pregnancies, parity and gestational age at delivery. Conclusions Women with GDM had a 10-fold higher risk of developing T2DM during a 10-year follow up period as compared to women with no GDM after controlling for other confounding variables.
Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women-A community based retrospective cohort study
(Public Library of Science, 2017) Herath, H.; Herath, R.; Wickremasinghe, R.
BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life compared to women with no GDM. This study was aimed to determine the risk of developing T2DM 10 years after GDM in Sri Lankan women. METHODS: A retrospective cohort study was conducted in the Colombo district, Sri Lanka. 7205 women who delivered a child in 2005 were identified through Public Health Midwives in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. One hundred and nineteen women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on history, relevant medical records and blood reports within the past 1 year. RESULTS: The mean duration of follow up was 10.9 (SD = 0.35) years in the GDM group and 10.8 (SD = 0.31) years in the non-GDM group. The incidence density of diabetes in the GDM group was 56.3 per 1000 person years compared to 5.4 per 1000 person years in non GDM group giving a rate ratio of 10.42 (95% CI: 6.01-19.12). A woman having GDM in the index pregnancy was 10.6 times more likely to develop diabetes within 10 years compared to women with no GDM after controlling for other confounding variables. Delivering a child after 30 years, being treated with insulin during the pregnancy and delivering a baby weighing more than 3.5 Kg were significant predictors of development of T2DM after controlling for family history of diabetes mellitus (DM), GDM in previous pregnancies, parity and gestational age at delivery. CONCLUSIONS: Women with GDM had a 10-fold higher risk of developing T2DM during a 10-year follow up period as compared to women with no GDM after controlling for other confounding variables.
Impact of Buyer-Supplier Relationship in Supply Chain Viability and Performance in the Apparel Industry: Evidence from Multi-Mediation Model
(Faculty of Commerce and Management Studies University of Kelaniya., 2024-11-01) Wickramaarachchi, W.N.T.L.; Herath, R.
In today's interconnected business landscape, no company can operate in isolation. Therefore, collaborative buyer-supplier relationships have become essential for sustaining and maintaining competitiveness. This has elevated the supply chain as a critical tool for strategy and competition. However, continuous natural disasters and pandemics have disrupted global supply chains, sparking interest in the concept of supply chain viability; the ability to adapt, survive and maintain performance over the long term in a changing environment. Consequently, the apparel industry which has been the largest gross export earner since 1986 faces variety of challenges throughout the value chain as they rely heavily on complex supply chains that span the globe. Moreover, continuous disruptions to the supply chain due to global as well as local incidents like COVID-19 epidemic, Israel-Hamas conflict, Houthi rebels’ issues in Red Sea, conflict between Russia and Ukraine, disputes between China-Thailand; India-Pakistan; South Korea-North Korea and China-USA over trade policies and territorial claims, Easter Sunday attack in Sri Lanka 2019, the political- economic upheavals (ARAGALAYA) from 2021 to 2022 and bankruptcy of Sri Lankan economy evident above issues go beyond the existing state of the art in supply chain viability dimensions like resilience, sustainability and agility as they cannot be resolved individually within each of these perspectives and require integrated frameworks and extension support like buyer-supplier relationships to perform and sustain in disrupted environment. Therefore, this study will build theoretical model based on Dynamic Capability Approach (DCA) and Network Theory (NT). The study will assess the hypotheses using partial least square-based structural equation modelling with data from all available Export garment factories (72) in Sri Lanka. The findings of this study will offer actionable recommendations for industry practitioners on how to build and maintain strong buyer-supplier relationships that contribute to achieving supply chain viability and enhancing supply chain performance in a disrupted environment.
Management of anaemia in pregnancy: experience from a Sri Lankan tertiary hospital unit
(Wiley-Blackwell, 2015) Palihawadana, T.; Dias, T.; Motha, C.; Thulya, S.D.; Herath, R.; Wijesinghe, P.S.
INTRODUCTION: Higher rates of pregnancy complications have been reported among anaemic pregnant women. Universal iron supplementation during pregnancy is recommended in countries where iron deficiency anaemia (IDA) prevalence rates are high. Sri Lanka also carries out a policy of such supplementation. The effectiveness of such programmes in different settings is variable. A retrospective analysis of the effectiveness of our current policy on prevention and treatment of anaemia was done for programme evaluation. METHODS: The North Colombo Obstetric Database (NORCOD) was used retrospectively to analyse the data between March and August 2014, at the university obstetric unit of the North Colombo Teaching Hospital, Sri Lanka. All singleton pregnancies without medical comorbidities were included in the analysis. Those who did not have haemoglobin (Hb) recording in the first trimester or in the third trimester were excluded at the data cleaning stage. An Hb level of <11 g/dL and a level of <10.5 g/dL were considered as anaemia in first and third trimesters respectively. The prevalence of anaemia at booking, and the Hb status in the third trimester were assessed. RESULTS: A total of 1340 singleton pregnancies were included in the analysis and 74 were excluded from the analysis due to incomplete data. 28.9% (n = 366) were found to be anaemic at booking while 63.9% (n = 809) were with a normal Hb and 7.1% (n = 91) were with an Hb of >13 g/dL. In the third trimester the prevalence of anaemia was 11.5% (n = 146) while 64.7% (n = 820) were with normal Hb and 23.6% (n = 300) were with an Hb of >13 g/dL. Among the anaemic women at booking, 22% (n = 81) persisted to be anaemic in the third trimester while 65% (n = 238) became normal and 12.8% (n = 47) developed a higher Hb level. Among those with a high Hb at booking only 1% became anaemic by third trimester while 40.6% persisted to have a high Hb level. CONCLUSION The prevalence of anaemia in this population was of moderate severity (>20% but <40%) as defined by the WHO. Major shortcoming in our practice is that we were unable to successfully treat nearly quarter of women who present with anaemia at booking, thus highlighting sub-optimal treatment. Furthermore, a policy of universal supplementation seems to over treat women with a high Hb at booking. Therefore, a more individualised supplementation and treatment policy should be encouraged in routine clinical practice.
Osteitis pubis following laparoscopic Burch colposuspension: A case report
(Elsevier B.V., 2021) Jayasundara, S.; Herath, R.
Osteitis pubis is a condition which predominantly affects young athletes. However, it may also occur following uro-gynecological interventions. We report a case of osteitis pubis following laparoscopic Burch colposuspension. There are several theories on the pathogenesis of postoperative osteitis pubis and a wide variety of treatment options have shown inconsistent outcomes. In our case, the condition was diagnosed radiologically and was managed with antibiotics and analgesics, which resulted in complete recovery.
Possible progression of an atypical leiomyoma to a leiomyosarcoma: a case report
(Menopause Society of Sri Lanka, 2021) Ekanayake, C.D.; Herath, R.; Fernando, S.; Mahendra, G.; Balawardene, J.; de Silva, A.
The spectrum of uterine smooth muscle cell tumours (SMT) ranges from leiomyomas to leiomyosarcomas (LMS). Atypical leiomyomas (AL) are a uterine SMT of a contentious nature due to its indeterminate malignant potential. Although the risk of recurrence is low there is limited experience on management. On the other hand, it is generally believed that the uterine LMS arises de novo, rather than from a precursor lesion.
Spontaneous ovarian hyperstimulation syndrome as a presenting manifestation of acquired hypothyroidism
(Sri Lanka College of Paediatricians, 2024) Kaluarachchi, D.P.; Casather, D.M.; Rathnayaka, R.M.A.N.; Ramachandran, R.; Herath, R.; Mettananda, S.
No abstract available
Term versus preterm induction of labor: Does it change the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.; Gunasena, J.; Herath, R.; Pieris, V.; Wijesinghe, P.
ABSTRACT: Induction of labour is important to timely deliver the fetus and minimize adverse perinatal outcomes to both the mother and the neonate. Therefore, comparison of the outcomes following induction of labour at term and preterm is invaluable to assess its benefits and detriments. OBJECTIVE: Compare fetal and labour outcomes following induction of preterm and term singleton pregnancies. METHOD:This was a retrospective studycarried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Six hundred and one singleton pregnancies that underwent induction of labour were included. Timing of induction of labor was categorized intopreterm labor induction (<38 weeks) and term labour induction (38-42 weeks). Vaginal delivery rate and neonatal outcomes were compared.RESULTS: Out of 601 cases 18.5% (N=111) were induced preterm and 81.5% (N=490) were induced at term. Vaginal delivery rates between the two groups were 71.2% (N=79) and 78.6% (N=385) (P>0.05). Preterm induced deliveries had an APGAR <7 at 5 minutes in 3 babies (2.7%) and six term babies(1.2%) had an APGAR <7 at 5 minutes (P>0.05). Preterm induced pregnancies reported 28.8% (N=32) NICU admissions and term induced pregnancies had 14.9% (N=73) NICU admissions (P<0.05). CONCLUSION: There’s no significant difference in LSCS rates and low 5 min APGAR among two groups. However preterm induction significantly increases NICU admission of the newborn, which is expected due to the complications associated with prematurity of the newborn.
Term versus preterm induction of labor: Does it change the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.; Gunasena, J.; Pieris, V.; Herath, R.; Wijesinghe, P.
ABSTRACT: Induction of labour is important to timely deliver the fetus and minimize adverse perinatal outcomes to both the mother and the neonate. Therefore, comparison of the outcomes following induction of labour at term and preterm is invaluable to assess its benefits and detriments. OBJECTIVE: Compare fetal and labour outcomes following induction of preterm and term singleton pregnancies. METHOD: This was a retrospective studycarried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Six hundred and one singleton pregnancies that underwent induction of labour were included. Timing of induction of labor was categorized intopreterm labor induction (<38 weeks) and term labour induction (38-42 weeks). Vaginal delivery rate and neonatal outcomes were compared. RESULTS: Out of 601 cases 18.5% (N=111) were induced preterm and 81.5% (N=490) were induced at term. Vaginal delivery rates between the two groups were 71.2% (N=79) and 78.6% (N=385) (P>0.05). Preterm induced deliveries had an APGAR <7 at 5 minutes in 3 babies (2.7%) and six term babies(1.2%) had an APGAR <7 at 5 minutes (P>0.05). Preterm induced pregnancies reported 28.8% (N=32) NICU admissions and term induced pregnancies had 14.9% (N=73) NICU admissions (P<0.05). CONCLUSION: There’s no significant difference in LSCS rates and low 5 min APGAR among two groups. However preterm induction significantly increases NICU admission of the newborn, which is expected due to the complications associated with prematurity of the newborn.
Toxoplasmosis awareness, seroprevalence and risk behavior among pregnant women in the Gampaha district, Sri Lanka
(London, UK : Maney Publishing., 2016) Chandrasena, N.; Herath, R.; Rupasinghe, N.; Samarasinghe, B.; Samaranayake, H.; Kasturiratne, A.; de Silva, N.R.
BACKGROUND: Primary gestational toxoplasmosis can be transmitted to the fetus with deleterious effects on the pregnancy. There is very little information regarding gestational toxoplasmosis in Sri Lanka. This survey was done to determine the prevalence and awareness of toxoplasmosis and to identify risk factors of infection among pregnant women in the Gampaha district, Sri Lanka. METHODS: Women attending obstetric clinics at the Colombo North Teaching Hospital in 2014 were tested for Toxoplasma gondii (T. gondii) specific Immunoglobulins G (IgG) and M (IgM) subtypes using the OnSite Toxo IgG/IgM Rapid Test-Dip Strip®. Disease awareness and risk behaviors of the participants were investigated. RESULTS: Of the 293 participants (mean age 27 years, SD ± 5.92), 38% were primigravidae with a mean gestational age of 16.2 weeks (SD 7). The prevalence of anti-T. gondii IgG and IgM antibodies was 12.3% (n = 36) and zero, respectively. Unadjusted and adjusted odds ratios were calculated to determine risk factors of infection (cat-ownership, handling cats, consumption of meat, commercial meals and unwashed raw vegetables and fruits, handling soil and not washing hands after handling soil). On bivariate analysis, eating commercially prepared meals weekly or more was associated with toxoplasma seroprevalence with marginal statistical significance. On multivariate analysis, none of the considered risk factors were significant. Toxoplasma awareness was 4.4% (n = 13); health personnel (46.2%, n = 6) and media (53.8%, n = 7) being sources of information. CONCLUSIONS: Health education programs to increase awareness of toxoplasmosis is recommended at antenatal clinics.
Vaginal, sexual and urinary symptoms following Hysterectomy: A Multi-centre randomized controlled trial.
(BioMed Central, 2020) Ekanayake, C.; Pathmeswaran, A.; Herath, R.; Wijesinghe, P.
BACKGROUND: Hysterectomy is the most common major gynaecological procedure. The aim of this study was to study vaginal, sexual and urinary symptoms following total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) in a low resource setting. METHODS: A multi-centre randomized controlled trial (RCT) was conducted in two public sector hospitals in Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus> 14 weeks, previous pelvic surgery, medical illnesses which contraindicated laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery.Vaginal, sexual function and urinary symptoms were assessed by the validated translations of ICIQ-VS and ICIQ-FLUTS questionnaires. Post-operative improvement (pre-operative - post-operative) was assessed. RESULTS: There was an improvement (median (IQ1-IQ3) in vaginal symptoms [TAH 6(2-8) vs 4(0-8), p < 0.001; NDVH 6(4-8.5) vs 5(0-8), p < 0.001; TLH 4(2-10.5) vs 4(0-10), p < 0.001], urinary flow symptoms [TAH 2(1-4) vs 1 (0-3), p < 0.001; NDVH 3 (2-5) vs 2 (0.5-4), p < 0.001; TLH 1(1-4) vs 1(0-3), p < 0.05], urinary voiding symptoms [TAH 0(0-0) vs 0(0-0), p = 0.20; NDVH 0(0-1) vs 0(0-0.8), p < 0.05; TLH 0(0-0) vs 0(0-0), p < 0.05] and urinary incontinence symptoms [TAH 0(0-2) vs 0(0-2), p = 0.06; NDVH 0(0-3) vs 0(0-3), p < 0.001; TLH 0(0-3) vs 0(0-2), p < 0.05] at 1-year (TAH n = 47, NDVH n = 45, TLH n = 47). There was an improvement in sexual symptoms only in the TLH group [TAH 0(0-11.5) vs 0(0-14), p = 0.08); NDVH 0(0-0) vs 0(0-0), p = 0.46; TLH 0(0-0) vs 0(0-4), p < 0.05].There was no significant difference among the three different routes in terms of vaginal symptoms score [TAH 2 (0-2), NDVH 0 (0-2), TLH 0 (0-2), p = 0.33], sexual symptoms [TAH 0 (0-0), NDVH 0 (0-0), TLH 0 (0-0), p = 0.52], urinary flow symptoms [TAH 0 (0-1), NDVH 0 (0-1), TLH 0 (0-2), p = 0.56], urinary voiding symptoms [TAH 0 (0-0), NDVH 0 (0-0), TLH 0 (0-0), p = 0.64] and urinary incontinence symptoms [TAH 0 (0-0), NDVH 0 (0-1), TLH 0 (0-1), p = 0.35] at 1-year. CONCLUSIONS: There was a post-operative improvement in vaginal symptoms and urinary symptoms in all three groups. There was no significant difference in pelvic organ symptoms between the three routes; TAH, NDVH and TLH. TRIAL REGISTRATION: Sri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111-1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515. KEYWORDS: Non-descent vaginal hysterectomy; Randomized controlled trial; Sexual symptoms; Total abdominal hysterectomy; Total laparoscopic hysterectomy; Urinary symptoms; Vaginal symptoms.