Urinary incontinence following subtotal and total hysterectomy: a systematic review

Impact of Hysterectomy on Quality of Life, Urinary Incontinence, Sexual Functions and Urethral Length

The aim of the study was to evaluate the influence of different types of hysterectomy on UI symptoms, quality of life and sexual functions using dedicated questionnaires. We investigated a correlation between the urethral length (UL), UI symptoms and the length of the cervix (left after LSH and SH) with sexual functions. The study enrolled 500 consecutive women referred for hysterectomy: 121 underwent VH, 171 underwent LSH, 96 underwent SH, 68 underwent TAH, and 44 underwent TLH. The patients filled in the UI-specific questionnaires and FSFI before and 12 months after hysterectomy. The UL was measured by introital ultrasound before and 12 months after hysterectomy. Before surgery, 137 out of 399 (34.3%) patients had UI symptoms; afterwards, 139 (34.8%) indicated the same (p > 0.05). There was no statistically significant difference in the UL in the patients before and after the procedure, and the cervix length did not differ between patients after LSH and SH. When the entire investigated population was analyzed, a significant improvement of the QoL was found on the IIQ-7. Hysterectomy performed due to benign diseases has effects on UI regardless of the surgical technique used. The UI symptoms improved only in the patients after LSH. The UL measured 12 months after hysterectomy did not change.

Incontinencia urinaria: causas y cuidados de enfermería. Una revisión bibliográfica

frecuencia en el sexo femenino y conforme aumenta la edad, provocando una disminución de la calidad de vida.Objetivo: Sintetizar la evidencia científica relacionada con las causas, tratamiento y cuidados de enfermería en la incontinencia urinaria.Metodología: Se ha realizado una revisión bibliográfica sistematizada en las bases de datos Proquest, Pubmed, Google Académico y Scielo, utilizando como términos "incontinencia urinaria" (urinary incontinence), "factoresde riesgo" (risk factor), "intervenciones de enfermería"(nursing intervention) y "procedimientos terapeúticos"(therapeutics), con una limitación de 5 años en la búsqueda. Se incluyeron estudios experimentales y de revisión.Resultados: Se incluyeron 26 artículos: 5 estudios experimentales,18 revisiones sistemáticas y 3 metaanálisis.La incontinencia urinaria está relacionada con la edad, sexo y factores de riesgo, dependiendo del tipo e intensidad de la incontinencia, y características propias del paciente. El abordaje es interdisciplinar, con técnicasmenos invasivas al principio, entre las que destacan la terapia conductual y los ejercicios del suelo pélvico; necesitándose cirugía en algunos casos, según las circunstanciasindividuales de los pacientes y/o la no existenciade mejoría con las técnicas menos invasivas.Conclusiones: La incontinencia urinaria se encuentra estrechamente relacionada con la edad y el sexo; sin embargo, la existencia de factores de riesgo y algunas causas pueden contribuir a aumentar las probabilidadesde su establecimiento. La labor enfermera resulta prometedora en el establecimiento de una detección y actuación precoz ante el problema, teniendo como base siempre para el tratamiento el menor grado de invasión.

Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors

INTRODUCTION AND HYPOTHESIS

Debate persists over whether surgery to correct pelvic organ prolapse (POP) should be combined with midurethral sling (MUS) insertion. The aim of this study was to evaluate the incidence of stress urinary incontinence (SUI) up to 12 months after transvaginal mesh surgery, with or without MUS, and to identify risk factors for postoperative SUI.

METHODS

This retrospective single-center study included patients who underwent transvaginal mesh surgery with Uphold™ between October 2010 and December 2017. The primary outcome was the prevalence of SUI at 12 months postoperatively. Univariate and multivariate logistic regression was used to identify risks factors for postoperative SUI.

RESULTS

Of the 308 women included, 123 (40%) were continent (no SUI), 108 (35%) had SUI, and 76 (25%) had occult SUI. Forty-nine patients (15.9%) had a concomitant MUS procedure. At 12 months after surgery, 35.9% of patients without concomitant MUS had SUI vs 14.3% with (p = 0.003). Thirty-five patients (29%) developed de novo SUI. Postoperative complications were more common in patients with concomitant MUS (30.6% vs 17%; p = 0.003). The best predictor of postoperative SUI was the presence of preoperative SUI (OR 2.52 (1.25-5.09). Concomitant MUS (p < 0.001), and prior POP surgery (p = 0.034) were protective factors for postoperative SUI.

CONCLUSION

Preoperative SUI is the most important risk factor for postoperative SUI. However, given the higher risk of postoperative complications with concomitant MUS and the acceptable rate of de novo SUI rate without it, two-stage surgery seems preferable for patients with preoperative SUI.

Current Resources for Evidence-Based Practice, November 2019

A review of new resources to support the provision of evidence-based care for women and infants.