The short-term prevalence of de novo urinary symptoms after different modes of hysterectomy

Abstract

The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9-45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.

Hysterectomy Is Associated with Stress Incontinence in Women Who Previously Had a Transcervical Endometrial Resection

“…The increased risk of urinary incontinence in subtotal hysterectomized women compared to total hysterectomized women shown by some investigators [10,11] is difficult to explain either from a theory based on nerve damage caused by dissection or on loss of support from adjacent pelvic connective tissue. As vaginal hysterectomy is becoming increasingly popular, it may be interesting to compare this operation to total abdominal hysterectomy with respect to later development of urinary symptoms.…”

“…Our study was not designed to compare different modes of hysterectomy, as randomization was not performed in the past. No previous study suggests, however, that one method is superior to the other [6,7,11] .…”

“…Gimbel et al [10] showed in a randomized study that women with previous supracervical hysterectomy had a significantly higher prevalence of urinary incontinence than women with previous total hysterectomy. In a non-randomized study, Neumann et al [11] showed a similar correlation between supracervical hysterectomy and late postoperative urological symptoms. …”

“…In January 2005, a questionnaire including items on urological matters (appendix) was sent to all traceable women. The questionnaire has previously been presented [11] . Data were stratified as the women had or had not a subsequent hysterectomy.…”

Urodynamic assessment of short-term effects of pelvic radiotherapy on bladder function in patients with gynecologic cancers

“…Short-term effects of hysterectomy and its influence on the lower urinary system functioning have been reported in retrospective studies [11,[13][14][15][16]. Frequency and urgency have been determined as the most common symptoms.…”