Hysterectomy unrelated to urinary incontinence

The risk of urge and stress incontinence is not increased with total hysterectomy, regardless of surgical approach, according to a new study.

Researchers, led by Dr. Catharina Gustaffson at the Karolinska Institutet and Danderyd Hospital in Stockholm, conducted an observational study of 120 patients undergoing total hysterectomy for benign causes. Of these, 44 underwent vaginal and 76 underwent abdominal hysterectomy. The average age at the time of surgery was 49.5 years.

All of the patients completed a questionnaire on symptoms of urge and stress incontinence before surgery. Follow-up questionnaires were conducted one and three years later. Data on 107 women were available for the full three years.

There was a significant decrease in symptoms of stress incontinence with both vaginal and abdominal hysterectomy. There was a small, statistically insignificant decrease in symptoms of urge incontinence in women who underwent abdominal hysterectomy.

Vaginal hysterectomy had no effect on the frequency of urination or on symptoms of stress or urge incontinence.

The team reports in the current issue of the journal Urology that they could not identify any risk factors for the development of urinary incontinence after hysterectomy.

One of the limitations of the study, the authors note, is that "several studies have shown considerable discrepancies between the severity of self-reported symptoms (of urinary incontinence) and the actual findings on urodynamic and radiologic studies."

However, in the ongoing debate over the risk of urinary incontinence following hysterectomy, the lack of worsening of symptoms overall and even some improvement in symptoms of urge incontinence suggest the procedure is safe, they add.

SOURCE: Urology, November 2006.