ArticlesHysterectomy and urinary incontinence: a systematic review
Introduction
In the USA, more than 600 000 women have hysterectomies each year, making this the second most common major surgical procedure done, after caesarean section.1 By age 60 years, about 40% of women in the USA have had a hysterectomy.2 Nearly 90% of hysterectomies are done for benign symptomatic disorders (uterine fibroids, vaginal bleeding, pelvic pain, and pelvic-organ prolapse), and most are elective. Fever is the most common perioperative complication of hysterectomy, arising in about 25%.3 Serious complications, including haemorrhage requiring transfusion, repair of adjacent organ injury, or life-threatening events, are seen in about 10% of cases,3 and the mortality rate has been reported as six women per 10 000 hysterectomies.4 On the basis of these data, hysterectomy is judged a safe surgical procedure. Possible long-term sequelae after hysterectomy are generally not taken into account or discussed with patients.
Hysterectomy may lead to damage to the pelvic nerves5, 6, 7 or pelvic supportive structures8, 9 that increases risk of urinary incontinence. Several studies have reported no rise in incontinence within 6–12 months of hysterectomy.10, 11, 12 Parity is a risk factor for urinary incontinence but incontinence does not increase substantially until several years after childbirth.13, 14, 15, 16 If the mechanism of incontinence after hysterectomy is similar to that for multiple births, incontinence may not develop for many years.
To find out whether urinary incontinence is a long-term sequela of hysterectomy, we reviewed and summarised data on urinary incontinence after hysterectomy.
Section snippets
Data sources
We searched English-language and non-English-language medical reports published from January, 1966, to December, 1997, on MEDLINE. We used key words including: hysterectomy (total, supracervical, supravaginal, and subtotal), genital surgery, and urinary incontinence. In addition, we searched the reference lists from identified articles and consulted with respected specialists.
Study selection
We included studies that presented primary data and compared incontinence in women who underwent hysterectomy with women
Results
45 articles reported urinary incontinence in women who underwent hysterectomy. Of these, 24 had no control group that did not undergo hysterectomy;6, 7, 9, 10, 11, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 seven did not provide odds estimates;26, 50, 51, 52, 53, 54, 55 and two had outcomes other than incontinence.5, 56 Therefore, we included 12 studies— eight cross-sectional14, 15, 17, 19, 20, 22, 23, 24 and two prospective cohort studies,12, 21 and one
Discussion
Results of the 11 observational studies that met our inclusion criteria suggest the odds of developing urinary incontinence after hysterectomy is about 40% higher than for women who have not undergone hysterectomy. Our results were, however, significantly heterogeneous. Because urinary incontinence might not develop for many years after hysterectomy, we stratified our analyses by age; the odds were increased 60% for women older than 60 years at first assessment. This finding corresponds with an
References (68)
- et al.
Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States: the Collaborative Review of Sterilization
Am J Obstet Gynecol
(1982) - et al.
The mortality risk associated with hysterectomy
Am J Obstet Gynecol
(1985) - et al.
The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women
J Urol
(1993) - et al.
Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life
Obstet Gynecol
(1997) - et al.
The menopause, urinary incontinence and other symptoms of the genito‐urinary tract
Maturitas
(1992) Medical correlates of urinary incontinence in the elderly
Urology
(1990)- et al.
Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group
Obstet Gynecol
(1996) - et al.
Meta‐analysis in clinical trials
Control Clin Trials
(1986) A post‐hysterectomy syndrome
Lancet
(1974)- et al.
Bladder wall mechanics and micturition before and after subtotal and total hysterectomy
Eur J Obstet Gynecol Reprod Biol
(1986)