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Yuk JS, Cho IC, Lee JH. The Risk of Stress Urinary Incontinence After Hysterectomy for Uterine Fibroids. Int Neurourol J 2023; 27:252-259. [PMID: 38171325 PMCID: PMC10762370 DOI: 10.5213/inj.2346192.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI). METHODS This study analyzed national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011 and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. One-to-one propensity score matching was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a diagnosis code for SUI. RESULTS After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years for the cases and 7.8 years for the controls. The incidence of anti-incontinence surgery was slightly but significantly higher in the cases than in the controls (2.0% vs. 1.7%, P<0.001). Compared to the control group, abdominal hysterectomy significantly increased the likelihood of anti-incontinence surgery both before (hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.116-1.365) and after adjusting for confounders (HR, 1.215; 95% CI, 1.097-1.347). In contrast, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery were not associated with an increased rate of anti-incontinence surgery. The significant association between abdominal hysterectomy and an elevated rate of anti-incontinence surgery persisted even after stratifying patients by age group. CONCLUSION Prior abdominal hysterectomy without adnexal surgery was associated with an increased incidence of subsequent anti-urinary incontinence surgery.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Inje University Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - In-Chang Cho
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Hysterectomy associated with de novo lower urinary tract symptoms in a Taiwanese population: a nationwide, population-based study. Int Urogynecol J 2018; 30:1711-1717. [DOI: 10.1007/s00192-018-3796-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
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Aukee P, Humalajärvi N, Kairaluoma MV, Valpas A, Stach-Lempinen B. Patient-reported pelvic floor symptoms 5 years after hysterectomy with or without prolapse surgery. Eur J Obstet Gynecol Reprod Biol 2018; 228:53-56. [PMID: 29909263 DOI: 10.1016/j.ejogrb.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/21/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of hysterectomy with or without concomitant prolapse surgery on subject-reported pelvic floor disorders (PFD) with a 5-year follow-up. STUDY DESIGN This prospective longitudinal study was carried out in two Finnish central hospitals among 286 women who had undergone hysterectomy for benign reasons. The presence of urinary incontinence, urinary frequency, feeling of vaginal bulging, constipation and anal incontinence was evaluated at baseline, 1 and 5 years postoperatively. Analysis was performed on 256 (895%) patients who answered at least one of the follow-up questionnaires. RESULTS Hysterectomy with concomitant native tissue prolapse surgery significantly reduced urinary incontinence, urinary frequency, constipation and the feeling of vaginal bulging, and the results were maintained over the following five years. Plain hysterectomy reduced urinary frequency and the feeling of vaginal bulging but did not relieve urinary incontinence. Hysterectomy had no effect on anal incontinence. The total subsequent prolapse and/or incontinence operation rate was 2,7%, and was higher among patients who underwent hysterectomy for pelvic organ prolapse. CONCLUSIONS During a 5-years follow-up a hysterectomy alone or with native tissue prolapse surgery did not worsen pelvic floor disorders.
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Affiliation(s)
- Pauliina Aukee
- Department of Obstetrics and Gynecology, Department of Pelvic Floor Research and Therapy Unit, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Niina Humalajärvi
- Department of Obstetrics and Gynecology, Department of Pelvic Floor Research and Therapy Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Matti V Kairaluoma
- Department of Surgery and Department of Pelvic Floor Research and Therapy Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Antti Valpas
- Department of Obstetrics and Gynecology, South Carelia Central Hospital, Lappeenranta, Finland
| | - Beata Stach-Lempinen
- Department of Obstetrics and Gynecology, South Carelia Central Hospital, Lappeenranta, Finland
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Heydari F, Motaghed Z, Abbaszadeh S. Relationship between hysterectomy and severity of female stress urinary incontinence. Electron Physician 2017; 9:4678-4682. [PMID: 28848647 PMCID: PMC5557152 DOI: 10.19082/4678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/08/2017] [Indexed: 11/20/2022] Open
Abstract
Background Stress Urinary Incontinence (SUI) is one of the most reported health dilemmas of women suffering from lower urinary tract symptoms. Aim To determine the relation between hysterectomy and severity of female SUI using Valsalva Leak Point Pressure (VLPP). Methods This case-control study was conducted at a public urology clinic in Tehran in 2015. The study population was all female with SUI complaints who visited the clinic during 2015. We compared Valsalva leak point pressure in two groups of female SUI patients with and without hysterectomy history. The inclusion criteria were: not taking any alpha-blocker or anti-cholinergic medicines two weeks prior to the urodynamic test as well as no history of pelvic surgery or cesarean delivery in their lifetime. All qualified patients were invited to participate in the study randomly, and among them, 120 qualified patients agreed to participate by filling out the informed consent form. Data was gathered through direct interview, and double checked by patients’ medical records. All the study variables including age, BMI, delivery number, hysterectomy and UTI history were entered and analyzed by estimating ordered logistic regression and by using Stata14.1 software. Results The mean of VLPP was 70.17 cmH2O in the group with hysterectomy history, and 94.55 cmH2O in those without hysterectomy history. The difference of VLPP pressure between the two studied groups were significant (p<0.05), even after control of confounding variables. Also, the odds of severe SUI among hysterectomy group patients was 6.3 times more than no hysterectomy (OR=6.32, p<0.001). Conclusions Our study confirms significant relation between hysterectomy and SUI severity measured by Valsalva leak point pressure. Hysterectomy patients are more likely to suffer from more severe grades of SUI.
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Affiliation(s)
- Fatemeh Heydari
- Assistant Professor, Department of Urology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Zahra Motaghed
- M.D, Department of Urology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shahin Abbaszadeh
- Assistant Professor, Department of Urology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation. OBJECTIVE The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders. DESIGN This was a prospective and longitudinal study. SETTINGS The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women's Health Research and Education Hospital between September 2008 and March 2011. PATIENTS The study was performed on patients who underwent hysterectomy for benign pathologies. MAIN OUTCOME MEASURES A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years. RESULTS Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4. LIMITATIONS Although the study had several limitations, no comparison with a control population was the most important one. CONCLUSIONS Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.
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Predicting urinary incontinence in women in later life: A systematic review. Maturitas 2016; 94:110-116. [PMID: 27823729 DOI: 10.1016/j.maturitas.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/09/2016] [Indexed: 11/21/2022]
Abstract
Urinary incontinence (UI) affects 10-40% of the population and treatment costs in the UK are estimated to be £233 million per annum. A systematic review of online medical databases between July 1974 and 2016 was conducted to identify studies that had investigated risk and prediction strategies of UI in later life. Eighteen prospective longitudinal studies fulfilled the search criteria. These were analysed systematically (as per the PRISMA checklist) and bias risk through study design was minimised where possible upon data analysis. One paper proposed a predictive assessment tool called the 'continence index'. It was derived following secondary analysis of a cohort study and its predictive threshold had suboptimal sensitivity (79%) and specificity (65%) rates. Seventeen studies identified multiple strong risk factors for UI but despite a large selection of papers on the topic, no robust risk assessment tool prospectively identified patients at risk of UI in later life. Thus more research in this field is required. Clinicians should be aware particularly of modifiable UI risk factors to help reduce the clinical burden of UI in the long term.
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Dwivedi R, Kapoor DS, Dix S. Does previous pelvic surgery hasten the onset of clinically bothersome urodynamic stress incontinence? Eur J Obstet Gynecol Reprod Biol 2013; 172:124-6. [PMID: 24209994 DOI: 10.1016/j.ejogrb.2013.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 07/31/2013] [Accepted: 09/27/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the impact of previous pelvic surgery on the onset of clinically bothersome urodynamic stress incontinence (USI). STUDY DESIGN Retrospective case-cohort study at a District General Hospital of 305 women undergoing surgery for urodynamic stress incontinence: case note and computer records review of patients undergoing USI surgery. The main outcome measures were age at index USI surgery, and duration from previous pelvic surgery to index surgery. RESULTS 305 women were included, of whom 118 had previous pelvic surgery including abdominal hysterectomy (TAH) (n=74), vaginal hysterectomy (n=23), anterior colporrhaphy (n=27) and posterior colporrhaphy (n=25). The mean age in the previous surgery group was 62.4 years (95% CI 60.2-64.6, range 32-87) and 53.2 years in the no previous surgery group (95% CI 51.4-55, range 30-88). There were no differences in the mean BMI (28.4 vs. 27.5), or mean parity (2.4 vs. 2.5). The median duration from previous surgery to the index USI surgery was 222 months (abdominal hysterectomy), 96 months (vaginal hysterectomy), 78 months (anterior colporrhaphy), and 72 months (posterior colporrhaphy). CONCLUSION Previous pelvic surgery does not seem to accelerate the onset of USI, as women without previous pelvic surgery presented at a significantly earlier age (53.2 years) with clinically bothersome USI than those who had previous surgery (62.4 years). Posterior colporrhaphy had the shortest interval to index USI surgery amongst previous operations.
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Affiliation(s)
- Rachana Dwivedi
- Department of Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom; Department of Urogynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom
| | - Dharmesh S Kapoor
- Department of Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom; Department of Urogynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom.
| | - Sarah Dix
- Department of Gynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom; Department of Urogynaecology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, United Kingdom
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Long-term effect of hysterectomy on urinary incontinence in Taiwan. Taiwan J Obstet Gynecol 2011; 50:326-30. [DOI: 10.1016/j.tjog.2011.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 11/16/2022] Open
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Balci O, Capar M, Acar A, Colakoglu MC. Balci technique for suspending vaginal vault at vaginal hysterectomy with reduced risk of vaginal vault prolapse. J Obstet Gynaecol Res 2011; 37:762-9. [PMID: 21395901 DOI: 10.1111/j.1447-0756.2010.01430.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the efficacy of a new technique of suspending the vaginal vault at vaginal hysterectomy (VH) for total uterine prolapse. MATERIAL AND METHODS This prospective study included 65 patients (group 1) in whom VH was performed using the new technique and 110 patients (group 2) in whom VH was performed using the traditional method. Both groups were followed up for 4 years. The incidences of vaginal vault prolapse (VVP), total vaginal length (TVL) (location of vaginal cuff), intraoperative and postoperative complications and sexual function were compared. RESULTS There were no statistically significant differences between the two groups regarding age, parity, body mass index (BMI), blood loss, intraoperative and postoperative complications, and sexual function. One (1.5%) patient had VVP in group 1, whereas 12 (10.9%) patients had VVP in group 2. TVL in group 1 was 8.9 ± 1.2 cm while in group 2 it was 5.9 ± 0.8 cm. The operation times were 57 ± 5 min and 76 ± 9 min in group 1 and group 2, respectively. There was a statistically significant difference between the two groups regarding VVP (P = 0.022), TVL (P < 0.001) and operation time (P < 0.001). The two groups were also compared regarding anterior and posterior prolapse after 4 years: group 1 had less anterior and posterior prolapse (stage II or more) than group 2 (P = 0.041, P = 0.047), respectively. CONCLUSION In this new technique, compared to the traditional technique, there was a lower incidence of VVP, greater TVL was achieved and the duration of the operation was shorter.
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Affiliation(s)
- Osman Balci
- Department of Obstetrics and Gynecology, Meram Medicine Faculty, Selcuk University, Konya, Turkey.
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Botlero R, Davis SR, Urquhart DM, Shortreed S, Bell RJ. Age-specific prevalence of, and factors associated with, different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire. Maturitas 2009; 62:134-9. [DOI: 10.1016/j.maturitas.2008.12.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/22/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
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Reproductive factors associated with nocturia and urinary urgency in women: a population-based study in Finland. Am J Obstet Gynecol 2008; 199:153.e1-12. [PMID: 18486094 DOI: 10.1016/j.ajog.2008.03.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/02/2008] [Accepted: 03/21/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the association of nocturia and urinary urgency with reproductive factors, including parity, the postpartum period, the menopause, hormone replacement therapy, hysterectomy, and surgery for stress urinary incontinence (SUI). STUDY DESIGN In 2003-2004, questionnaires eliciting urinary symptoms, reproductive factors, SUI surgery, and potential confounders were mailed to 3000 randomly selected women aged 18-79 years, identified from the Finnish Population Register. Nocturia was defined as 2 or more voids/night. Sudden compelling desire to urinate often or always (scale of never, rarely, often, always) was regarded as urgency. Pregnant and puerperal (6 weeks after delivery) women and those reporting urinary tract infection were excluded. RESULTS Responses totaled 2002 (67%). Parity, postpartum (defined as six weeks to one year after delivery) and postmenopausal periods were associated with increased nocturia and SUI surgery with increased urgency (adjusted for age, comorbidity, medication, anthropometric, sociodemographic and lifestyle factors). Hormone therapy and hysterectomy were associated with neither symptom. CONCLUSION Reproductive factors associated with nocturia differed from those related to urgency.
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Miller JJR, Botros SM, Beaumont JL, Aschkenazi SO, Gamble T, Sand PK, Goldberg RP. Impact of hysterectomy on stress urinary incontinence: an identical twin study. Am J Obstet Gynecol 2008; 198:565.e1-4. [PMID: 18455535 DOI: 10.1016/j.ajog.2008.01.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 11/19/2007] [Accepted: 01/24/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study uses the unique properties of twin research design to evaluate whether hysterectomy impacts stress urinary incontinence (SUI). STUDY DESIGN As part of the Evanston Twins Sister Study, we performed bivariate and multivariate analyses on 83 identical twin pairs discordant for hysterectomy. RESULTS In bivariate analysis, SUI was less common in women who had prior hysterectomy (P =0.028). Multivariate analysis suggested that SUI was significantly less common after hysterectomy (odds ratio [OR], 0.55, confidence interval [CI], 0.30 to 1.00). Exclusion of twin pairs with a history of pelvic floor defect surgery eliminated the statistical relationship between hysterectomy and SUI (OR, 0.79, CI, 0.4 to 1.40). CONCLUSION Hysterectomy, when analyzed with all cases, was associated with reduced SUI. When concurrent pelvic floor defect surgeries were excluded from the analysis, we found no relationship between hysterectomy and the risk of SUI afterward.
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Affiliation(s)
- Adam Magos
- Royal Free Hospital, London NW3 2QG, UK.
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Dällenbach P, Kaelin-Gambirasio I, Dubuisson JB, Boulvain M. Risk Factors for Pelvic Organ Prolapse Repair After Hysterectomy. Obstet Gynecol 2007; 110:625-32. [PMID: 17766610 DOI: 10.1097/01.aog.0000278567.37925.4e] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the incidence and identify the risk factors for pelvic organ prolapse repair after hysterectomy. METHODS We conducted a case-control study. We identified 6,214 women who underwent hysterectomy in our gynecology department from 1982 to 2002. Cases (n=114) were women who required pelvic organ prolapse surgery after hysterectomy from January 1982 through December 2005. Controls (n=236) were women randomly selected from the same cohort who did not require pelvic organ surgery during the same period. We performed a univariable and a multivariable analysis among 104 cases and 190 controls to identify the variables associated with prolapse repair after hysterectomy. RESULTS The incidence of pelvic organ prolapse that required surgical correction after hysterectomy was 1.3 per 1,000 women-years. The risk of prolapse repair was 4.7 times higher in women whose initial hysterectomy was indicated by prolapse and 8.0 times higher if preoperative prolapse grade 2 or more was present. Risk factors included preoperative prolapse grade 2 or more (adjusted odds ratio [OR] 12.6, 95% confidence interval [CI] 4.6-34.7), previous pelvic organ prolapse or urinary incontinence surgery (adjusted OR 7.9, 95% CI 1.3-48.2), history of vaginal delivery (adjusted OR 5.0, 95% CI 1.3-19.7), and sexual activity (adjusted OR 6.2, 95% CI 2.7-14.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (adjusted OR 0.7, 95% CI 0.4-1.1). CONCLUSION Preoperative pelvic organ prolapse and other factors related to pelvic floor weakness were significantly associated with subsequent pelvic floor repair after hysterectomy. Vaginal hysterectomy was not a risk factor. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Patrick Dällenbach
- Department of Gynecology and Obstetrics, Division of Gynecology, Urogynecology Unit, Geneva University Hospitals, Geneva, Switzerland.
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