Skip to main content

Advertisement

SpringerLink
Log in

Lower urinary tract symptoms after total and subtotal hysterectomy: results of a randomized controlled trial

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

The aim of this Danish multicenter trial was to compare the proportion of women with lower urinary tract symptoms after total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) for benign uterine disorders. A total of 319 women were randomized to TAH (n=158) or SAH (n=161). Women were followed up for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention-to-treat analyses. Urinary incontinence was found less often among TAH women than among SAH women. This was due to a larger reduction of the number of women with stress and urinary incontinence in the TAH group. No other differences were found between the two operation methods. The number of women with urinary incontinence and frequency was reduced from study entry for follow-up, while double/triple voiding was increased. Incontinent women had significantly lower quality of life scores than continent women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gimbel H, Settnes A, Tabor A (2001) Hysterectomy on benign indication in Denmark 1988–1998. A register based trend analysis. Acta Obstet Gynecol Scand 80:267–272

    Article  PubMed  Google Scholar 

  2. Vuorma S, Terperi J, Hurskainen R, Keskimäki I, Kujansuu E (1998) Hysterectomy trends in Finland in 1987–1995—a register based analysis. Acta Obstet Gynecol Scand 77:770–776

    Article  PubMed  Google Scholar 

  3. Sills ES, Saini J, Applegate MS, McGee M III, Gretz HF III (1998) Supracervical and total abdominal hysterectomy trends in New York State: 1990–1996. J Urban Health 75:903–910

    PubMed  Google Scholar 

  4. Bridgman SA, Dunn KM (2000) Has endometrial ablation replaced hysterectomy for the treatment of dysfunctional uterine bleeding? National figures. Br J Obstet Gynaecol 107:531–534

    Google Scholar 

  5. Sommer P, Bauer T, Nielsen KK, Kristensen ES, Hermann GG, Steven K et al (1990) Voiding patterns and prevalence of incontinence in women: a questionnaire survey. Br J Urol 66:12–15

    PubMed  Google Scholar 

  6. Samuelson E, Victor A, Tibblin G (1997) A population study of urinary incontinence and nocturia among women aged 20–59 years: prevalence, well-being and wish for treatment. Acta Obstet Gynecol Scand 76:74–80

    PubMed  Google Scholar 

  7. Simeonova Z, Milsom I, Kullendorff M, Molander U, Bengtsson C (1999) The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population. Acta Obstet Gynecol Scand 78:546–551

    Article  PubMed  Google Scholar 

  8. Milson I (2000) The prevalence of urinary incontinence. Acta Obstet Gynecol Scand 79:1056–1059

    Article  PubMed  Google Scholar 

  9. Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B (1993) The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women. J Urol 149:1459–1462

    PubMed  Google Scholar 

  10. Thom DH, van den Eeden SK, Brown JS (1997) Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life. Obstet Gynecol 90:983–939

    Article  PubMed  Google Scholar 

  11. Møller LA, Lose G, Jørgensen T (2000) Risk factors for lower urinary tract symptoms in women 40 to 60 years of age. Obstet Gynecol 96:446–451

    Article  PubMed  Google Scholar 

  12. Mommsen S, Foldspang A (1994) Body mass index and adult female urinary incontinence. World J Urol 12:319–322

    Article  PubMed  Google Scholar 

  13. Brown JS, Seeley DG, Fong J, Black DM, Ensrud KE, Grady D (1996) Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group. Obstet Gynecol 87:715–721

    Article  PubMed  Google Scholar 

  14. Graham CA, Mallett VT (2001) Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 185:116–120

    Article  PubMed  Google Scholar 

  15. Brown JS, Sawaya G, Thorn DH, Grady D (2000) Hysterectomy and urinary incontinence: a systematic review. Lancet 356:535–539

    Article  PubMed  Google Scholar 

  16. Gimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A (2003) Danish Hysterectomy Group. Randomised controlled trial of total versus subtotal hysterectomy with one-year follow up results. BJOG 110:1088–1098

    PubMed  Google Scholar 

  17. Rannestad T, Eikeland O-J, Helland H, Qvarnström U (2001) The quality of life in women suffering from gynecological disorders is improved by means of hysterectomy: absolute and relative differences between pre- and postoperative measures. Acta Obstet Gynecol Scand 80:46–51

    Article  PubMed  Google Scholar 

  18. Grimby A, Milsom I, Molander U, Wiklund I, Ekelund P (1993) The influence of urinary incontinence on the quality of life in elderly women. Age Ageing 22:82–89

    PubMed  Google Scholar 

  19. Robinson D, Pearce KF, Preisser JS, Dugan E, Suggs PK, Cohen SJ (1998) Relationship between patient reports of urinary incontinence and quality of life measures. Obstet Gynecol 91:224–228

    Article  PubMed  Google Scholar 

  20. Lalos O, Bjerle P (1986) Bladder wall mechanics and micturition before and after subtotal and total hysterectomy. Eur J Obstet Gynecol Reprod Biol 21:143–150

    Article  PubMed  Google Scholar 

  21. Thakar R, Manyonda I, Stanton S, Ayers S, Clarkson P, Robinson G (2002) Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 347:1318–1325

    Article  PubMed  Google Scholar 

  22. Learman LA, Summitt RL Jr, Varner RE, McNeeley SG, Goodman-Gruen D, Richter HE, Lin F, Showstack J, Ireland CC, Vittinghoff E, Hulley SB, Washington AE et al (2003) A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol 102:453–462

    Article  PubMed  Google Scholar 

  23. Lauridsen L, Jensen VC (1961) Total contra subtotal hysterektomi [Total contra subtotal hysterectomy]. Ugeskr Læger 123:298–307

    PubMed  Google Scholar 

  24. Iosif CS, Bekassy Z, Rydhström H (1988) Prevalence of urinary incontinence in middle-aged women. Int J Gynaecol Obstet 26:255–259

    Article  PubMed  Google Scholar 

  25. Kilkku P (1985) Supravaginal uterine amputation versus hysterectomy with reference to subjective bladder symptoms and incontinence. Acta Obstet Gynecol Scand 64:375–379

    PubMed  Google Scholar 

  26. Kilkku P, Hirvonen T, Gronroos M (1981) Supra-vaginal uterine amputation vs. abdominal hysterectomy: the effect on urinary symptoms with special reference to pollakisuria, nocturia and dysuria. Maturitas 3:197–204

    PubMed  Google Scholar 

  27. Ruoss CF (1995) Supravaginal hysterectomy—a less invasive procedure. J Obstet Gynecol 15:406–409

    Google Scholar 

  28. Kujansuu E, Teisala K, Punnonen R (1989) Urethral closure function after total and subtotal hysterectomy measured by urethrocystometry. Gynecol Obstet Invest 27:105–106

    PubMed  Google Scholar 

  29. Gimbel H, Zobbe V, Ottesen B, Tabor A (2002) Randomized clinical trial of total versus subtotal hysterectomy: validation of the trial questionnaire. Acta Obstet Gynecol Scand 81:968–974

    Article  PubMed  Google Scholar 

  30. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing. Br J Urol 77:805–812

    PubMed  Google Scholar 

  31. Bernstein I, Sejr T, Abel I, Andersen JT, Fischer-Rasmussen W, Klarskov P, Lose G, Madsen H, Mortensen S, Tetzschner T, Walter S (1996) Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: test-retest reliability. Int Urogynecol J Pelvic Floor Dysfunct 7:37–47

    PubMed  Google Scholar 

  32. Ryhammer AM, Laurberg S, Djurhuus JC, Hermann AP (1998) No relationship between subjective assessment of urinary incontinence and pad test weight gain in a random population sample of menopausal women. J Urol 159:800–803

    Article  PubMed  Google Scholar 

  33. Simons AM, Yoong WC, Buckland S, Moore KH (2001) Inadequate repeatability of the one-hour pad-test: the need for a new incontinence outcome measure. Br J Obstet Gynaecol 108:315–319

    Article  Google Scholar 

  34. Homma Y, Ando T, Yoshida M, Kageyama S, Takei M, Kimto K, Ishizuka O, Gotoh M, Hashimoto T (2002) Voiding and incontinence frequencies: variability of diary data and required diary length. Neurourol Urodyn 23:204–209

    Article  Google Scholar 

  35. Summit RL, Bent AE (1996) Genuine stress incontinence: an overview. In: Ostergaard DR, Bent AE (eds) Urogynecology and urodynamics. Theory and practice. Williams and Wilkins, Baltimore, pp 493–505

    Google Scholar 

  36. Mouritsen L, Rasmussen A (1993) Bladder neck mobility evaluated by vaginal ultrasonography. Br J Urol 7:166–171

    Google Scholar 

  37. Käser O, Iklé FA, Hirsch HA (1985) Atlas of gynecological surgery. Georg Thieme Verlag, Stuttgart, p 7.4

    Google Scholar 

  38. Demirci F, Ozden S, Alpay Z, Demirci ET (1999) The effect of abdominal hysterectomy on bladder neck and urinary incontinence. Aust N Z J Obstet Gynecol 39:239–242

    Google Scholar 

  39. Penttinen J, Lindholm EL, Kaar K, Kauppila A (1989) Successful colposuspension in stress incontinence reduces bladder neck mobility and increases pressure transmission to the urethra. Arch Gynecol Obstet 244:233–238

    Article  PubMed  Google Scholar 

  40. Mouritsen L (2001) Effect of vaginal devices on bladder neck mobility in stress incontinent women. Acta Obstet Gynecol Scand 80:428

    PubMed  Google Scholar 

  41. Haylen BT, Law MG, Frazer M, Schulz S (1999) Urine flow rates and residual urine volumes in urogynecology patients. Int Urogynecol J Pelvic Floor Dysfunct 10:378–383

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We wish to thank our colleagues from the Department of Obstetrics and Gynecology, Hvidovre Hospital, as well as Dorte Nielsen, MD, Head of Department, Department of Obstetrics and Gynecology, Frederiksberg Hospital, and Prof. Gunnar Lose, MD, DrSci, for discussions and their critical comments to the interpretation of the results. Further, we wish to thank Jakob Hjort for his skilled generation of the allocation sequence and excellent management of the randomization procedure and program. We wish to thank Peter Olesen, MD, Kirsten Rylev Larsen, MD, Marlene Mohr, MD, and Namreen Chouhan, MD, for assistance regarding recruitment of patients. We wish to thank Lars Schouenborg, MD, and Lisbeth Nilas, MD, DrSci, for the categorization of the postoperative complications. Finally, we wish to thank Jan Blaakær, MD, DrSci, and Jørgen Hilden, MD, for their work in the Data Monitoring and Safety Committee. This study has been supported by grants from the Health Insurance Fond, the Copenhagen Hospital Corporation’s Medical Research Council, the Danish Medical Research Council, the Foundation Supporting Medical Research in Roskilde, Vestsjællands, Storstrøms, Frederiksborg and Bornholms Counties, the Højmosegård Foundation, Organon’s Foundation supporting Gynecological Research, the Roskilde County Hospital, the Copenhagen Trial Unit, and the Research Foundation at the Department of Gynecology and Obstetrics, H:S Hvidovre Hospital.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Roskilde County Hospital, Roskilde, Denmark

    Helga Gimbel, Vibeke Zobbe & Birthe Margrethe Andersen

  2. Department of Gynecology and Obstetrics, H:S Hvidovre Hospital, Roskilde, Denmark

    Helga Gimbel, Bent S. Ottesen & Ann Tabor

  3. Department of Gynecology and Obstetrics, D H:S Rigshospitalet, Roskilde, Denmark

    Helga Gimbel

  4. Copenhagen Trial Unit, Center for Clinical Intervention Research, H:S Rigshospitalet, Roskilde, Denmark

    Helga Gimbel, John Villumsen & Christian Gluud

  5. Department of Gynecology and Obstetrics, Slagelse County Hospital, Roskilde, Denmark

    Thomas Filtenborg

  6. Department of Gynecology and Obstetrics, Hillerød County Hospital, Roskilde, Denmark

    Kristian Jakobsen, Helle Christina Sørensen & Kim Toftager-Larsen

  7. Department of Gynecology and Obstetrics, Glostrup County Hospital, Roskilde, Denmark

    Katrine Sidenius & Nini Møller

  8. Department of Gynecology and Obstetrics, Gentofte County Hospital, Roskilde, Denmark

    Ellen Merete Madsen

  9. Department of Gynecology and Obstetrics, Herlev County Hospital, Roskilde, Denmark

    Mogens Vejtorp & Helle Clausen

  10. Department of Gynecology and Obstetrics, Holstebro County Hospital, Roskilde, Denmark

    Annie Rosgaard

Authors
  1. Helga Gimbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vibeke Zobbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Birthe Margrethe Andersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Filtenborg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristian Jakobsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helle Christina Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kim Toftager-Larsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katrine Sidenius
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nini Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ellen Merete Madsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mogens Vejtorp
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Helle Clausen
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Annie Rosgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. John Villumsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Christian Gluud
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Bent S. Ottesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Ann Tabor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helga Gimbel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gimbel, H., Zobbe, V., Andersen, B.M. et al. Lower urinary tract symptoms after total and subtotal hysterectomy: results of a randomized controlled trial. Int Urogynecol J 16, 257–262 (2005). https://doi.org/10.1007/s00192-005-1291-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-005-1291-8

Keywords

Search

Navigation