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Yuk JS, Lee JH. Risk of overactive bladder after hysterectomy for uterine fibroids. Int Urogynecol J 2023; 34:1823-1829. [PMID: 36752850 DOI: 10.1007/s00192-023-05474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated the association between previous hysterectomy for uterine fibroids and the risk of developing overactive bladder (OAB). METHODS We used national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine leiomyoma or adenomyosis between 1 January 2011 and 31 December 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time period. Propensity score matching (PSM, 1:1) was performed to balance confounders. OAB events were defined by drug prescriptions (beta 3 agonist or anticholinergics) for more than 1 month based on previous studies. RESULTS After matching, 58,195 cases (hysterectomy group) and 58,195 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years in the nonhysterectomy group and 8.0 years in the hysterectomy group. There was no significant difference in the rate of OAB development between the groups (0.3% vs 0.3%; p=0.061). Additionally, compared with the nonhysterectomy group (hazard ratio: 1 (reference)), hysterectomy without adnexal surgery (hazard ratio: 1.169 [0.915-1.493]) and hysterectomy with adnexal surgery (hazard ratio: 1.342 [0.83-2.171]) did not significantly increase the risk of OAB after adjusting for confounders; this relationship remained nonsignificant after stratifying patients according to age group. CONCLUSIONS Previous hysterectomy with or without adnexal surgery for the treatment of uterine fibroids did not increase the risk of developing OAB, defined as drug therapy lasting more than 1 month.
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Affiliation(s)
- Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University School of Medicine, 327, Gongneung-ro, Nowon-gu, Seoul, 01830, South Korea.
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Harendarczyk L, Cardaillac C, Vaucel E, Joueidi Y, Gueudry P, Dochez V, Thubert T. [Impact of hysterectomy on urinary incontinence: A systematic review]. Prog Urol 2020; 30:1096-1117. [PMID: 32651102 DOI: 10.1016/j.purol.2020.06.002] [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: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact of a hysterectomy on urinary incontinence is a controversial subject in the literature. OBJECTIVE To evaluate the prevalence and incidence of urinary incontinence after a hysterectomy as well as associated risk factors such as the type of hysterectomy, the surgical approach, urodynamic criteria and uterine disease. STUDY DESIGN We conducted a systematic review in Pubmed database with the following keywords and MeSH term: hysterectomy, urinary incontinence. RESULTS A total of 1340 articles were retrieved, 42 articles were selected for the final text analysis. The results of the different studies were heterogeneous. Hysterectomy seemed to increase the rate of sphincter deficiency (VLPP<60mmH2O for 20% of cases versus 1,7% without hysterectomy, P=0.003). The vaginal route could increase the incidence of UI with OR of 2.3 (95%CI 1.0-5.2). Subtotal hysterectomy appears to increase UI with a 0,74 RR for total hysterectomy (95%CI 0.58-0.94). A radical hysterectomy with nerve conservation would preserve urinary functions, unlike pelvic radiotherapy, which is responsible for irreversible nerve damage by demyelination and bladder fibrosis.
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Affiliation(s)
- L Harendarczyk
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - C Cardaillac
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - E Vaucel
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - Y Joueidi
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - P Gueudry
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - V Dochez
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigations clinique, CHU de Nantes, 5, allée de l'Ile-Gloriette, 44093 Nantes cedex 01, France
| | - T Thubert
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; CIC, centre d'investigations clinique, CHU de Nantes, 5, allée de l'Ile-Gloriette, 44093 Nantes cedex 01, France; Centre fédératif de pelvi-périnéologie, France.
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Mourgues J, Villot A, Thubert T, Fauvet R, Pizzoferrato AC. Uterine myomas and lower urinary tract dysfunctions: A literature review. J Gynecol Obstet Hum Reprod 2019; 48:771-774. [PMID: 30905852 DOI: 10.1016/j.jogoh.2019.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 12/12/2022]
Abstract
Different types of urinary symptoms associated with myomas are reported, including urinary incontinence or dysuria. They are rarely investigated in patients and their prevalence is not well known. While myomas are the first reason to perform hysterectomy in France, few studies have evaluated the impact of surgical treatment in women with urinary symptoms. Our objective was to conduct a review of the literature regarding urinary symptoms associated with myomas and the impact of their treatment on these symptoms. We reviewed articles indexed in MEDLINE dealing with urinary symptoms and myomas, and published until September 2018. The prevalence of urinary symptoms in women with uterine myomas is highly variable depending on whether the authors are interested in symptoms or urodynamic results. The most frequently reported urinary symptoms are urgency (31-59%), dysuria (4-36%) and stress urinary incontinence (SUI, 20 80%). While some studies have found the anterior location of myomas and the size superior to 5 cm as a risk factor for UI, other studies have not found a correlation between myomas topography and symptom scores. The treatments of uterine myomas seem to have an impact on women's urinary symptoms. Although hysterectomy is considered as a risk factor for pelvic floor disorders, the removal of the uterus may sometimes improve or cure urinary symptoms. Most authors also found a significant improvement in urinary symptom scores after myomectomy and myomas embolization. More studies are needed to clarify the impact of myomas treatment on urinary symptoms.
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Affiliation(s)
- Julie Mourgues
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France
| | - Anne Villot
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France
| | - Thibault Thubert
- Department of Gynaecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Raffaèle Fauvet
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, Unité de recherche Inserm U1086 « ANTICIPE » - Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), Caen, France
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Koch M, Rauchenwald T, Kivaranovic D, Schwab S, Umek W, Koelbl H, Rauchenwald M, Helmy S. Association of uterine leiomyoma and overactive bladder syndrome. Int J Gynaecol Obstet 2018; 142:365-369. [DOI: 10.1002/ijgo.12545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Marianne Koch
- Department of Obstetrics and Gynecology; Clinical Division of General Gynecology and Gynecologic Oncology; Medical University of Vienna; Vienna Austria
- Karl Landsteiner Institut fuer Spezielle Gynaekologie und Geburtshilfe; Vienna Austria
| | - Tina Rauchenwald
- Department of Obstetrics and Gynecology; Clinical Division of General Gynecology and Gynecologic Oncology; Medical University of Vienna; Vienna Austria
| | - Danijel Kivaranovic
- Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Stephanie Schwab
- Department of Obstetrics and Gynecology; St. Josef Spital; Vienna Austria
- Karl Landsteiner Institut fuer Diagnostik und Therapie in der Frauenheilkunde; Vienna Austria
| | - Wolfgang Umek
- Department of Obstetrics and Gynecology; Clinical Division of General Gynecology and Gynecologic Oncology; Medical University of Vienna; Vienna Austria
- Karl Landsteiner Institut fuer Spezielle Gynaekologie und Geburtshilfe; Vienna Austria
| | - Heinz Koelbl
- Department of Obstetrics and Gynecology; Clinical Division of General Gynecology and Gynecologic Oncology; Medical University of Vienna; Vienna Austria
| | - Michael Rauchenwald
- Department of Urology and Andrology; Sozialmedizinisches Zentrum Ost- Donauspital; Vienna Austria
| | - Samir Helmy
- Department of Obstetrics and Gynecology; Clinical Division of General Gynecology and Gynecologic Oncology; Medical University of Vienna; Vienna Austria
- Karl Landsteiner Institut fuer Diagnostik und Therapie in der Frauenheilkunde; Vienna Austria
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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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6
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Urinary Dysfunction after Hysterectomy: Incidence, Risk Factors and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0442-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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7
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Kudish BI, Shveiky D, Gutman RE, Jacoby V, Sokol AI, Rodabough R, Howard BV, Blanchette P, Iglesia CB. Hysterectomy and urinary incontinence in postmenopausal women. Int Urogynecol J 2014; 25:1523-31. [DOI: 10.1007/s00192-014-2422-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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The relationship between uterine leiomyomata and pelvic floor symptoms. Int Urogynecol J 2013; 25:241-8. [PMID: 23922009 DOI: 10.1007/s00192-013-2183-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To compare pelvic floor symptoms in women with a leiomyomatous uterus ≤12 weeks and those >12 weeks in size and to evaluate the resolution of these symptoms after surgical intervention. METHODS The PFDI-20, PFIQ-7 and 3-day voiding diaries were administered prospectively to all subjects. Demographics and questionnaire responses were compared using a t test, Chi-squared test or Mann-Whitney U test as indicated. RESULTS One hundred and forty-five women completed the questionnaires and were included for analysis. There were 58 women with uterine size ≤12 weeks (group I) and 87 women with size >12 weeks (group II). Participants in group I reported more straining to defecate (p = 0.042), while group II reported increased feeling of incomplete bladder emptying (p = 0.007) and difficulty emptying their bladder (p = 0.008). Review of ultrasound images revealed no difference in pelvic floor symptoms when stratified by leiomyoma location. At 1-year follow-up, 69 women (48 %) responded, and 40 (58 %) had undergone surgical intervention. Surgery was shown to improve symptoms for all questions reviewed at 1-year follow-up. CONCLUSIONS A leiomyomatous uterus >12 weeks is associated with the symptom of incomplete bladder emptying, but does not appear to have an effect on other pelvic floor symptoms compared with women with a smaller leiomyomatous uterus. Surgical intervention for leiomyomata improves pelvic floor symptoms.
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9
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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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10
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Debodinance P, Fatton B, Lucot JP. Faut-il faire une hystérectomie au cours de la chirurgie du prolapsus par voie vaginale ? Prog Urol 2009; 19:1060-73. [DOI: 10.1016/j.purol.2009.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 09/28/2009] [Indexed: 11/28/2022]
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Fatton B, Wagner L, Delmas V, Haab F, Costa P. Place de l’hystérectomie lors de la cure de prolapsus par promontofixation. Prog Urol 2009; 19:1006-13. [DOI: 10.1016/j.purol.2009.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 11/25/2022]
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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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Robert M, Soraisham A, Sauve R. Postoperative urinary incontinence after total abdominal hysterectomy or supracervical hysterectomy: a metaanalysis. Am J Obstet Gynecol 2008; 198:264.e1-5. [PMID: 18199420 DOI: 10.1016/j.ajog.2007.09.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 07/14/2007] [Accepted: 09/19/2007] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A metaanalysis of randomized trials was conducted to evaluate if the type of hysterectomy, total abdominal hysterectomy or supracervical hysterectomy, has an impact on the development of urinary incontinence. STUDY DESIGN We searched MEDLINE, EMBASE, CINAHL, Biological Abstract, and the Cochrane Library up to February 2007; abstracts at major meetings and bibliographies of retrieved articles were scanned. A fixed effect model was used to calculate summary relative risk estimates and 95% confidence intervals (CIs). RESULTS Analysis showed no statistical difference in the risk of developing stress or urge urinary incontinence in women who underwent supracervical hysterectomy compared with women who underwent total abdominal hysterectomy (relative risk, 1.3; 95% CI, 0.94-1.78; P = 0.16 and relative risk, 1.37; 95% CI, 0.77-2.46; P = .25). CONCLUSION There is no statistical evidence of a different risk for developing either stress or urge urinary incontinence after a supracervical hysterectomy or a total hysterectomy.
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Affiliation(s)
- Magali Robert
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
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Affiliation(s)
- Adam Magos
- Royal Free Hospital, London NW3 2QG, UK.
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Fatton B, Amblard J, Jacquetin B. Faut-il réaliser une hystérectomie lors de la cure de prolapsus? ACTA ACUST UNITED AC 2007; 41:91-109. [DOI: 10.1016/j.anuro.2007.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Krogh RA, Neumann GA, Lauszus FF, Guttorm E, Rasmussen KL. Hysterectomy Is Associated with Stress Incontinence in Women Who Previously Had a Transcervical Endometrial Resection. Gynecol Obstet Invest 2006; 63:121-5. [PMID: 17057396 DOI: 10.1159/000096433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 08/19/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare the prevalence of urological symptoms in a population of women, who had a transcervical endometrial resection (TCER) only, and a population of women, who had a TCER and a subsequent hysterectomy. The superior goal was to evaluate the possible association between hysterectomy and urinary incontinence. DESIGN All women, who had a TCER at our department during the period of 1990-1996 received a questionnaire with focus on urological symptoms. The answers from women, who later had a hysterectomy were compared to the answers from women, who were sufficiently treated with TCER only. RESULTS Of 356 women, who were alive, 16 were lost to follow-up, leaving 340 women to receive the questionnaire, which was returned by 310 women (85%). Ninety-three (31%) had a subsequent hysterectomy mainly indicated by metrorrhagia or dysmenorrhea. Of the hysterectomized women 24% reported bothersome stress incontinence against 14% in the group of women, who had TCER only (p = 0.03). No significant difference was seen with respect to urge incontinence, urgency, pollakisuria or nocturia. Significantly more women with a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to women with a slightly enlarged uterus. CONCLUSION Hysterectomy is significantly associated with stress urinary incontinence in women, who previously had a TCER.
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Affiliation(s)
- Rubab Agha Krogh
- Department of Gynecology and Obstetrics, Herning/Holstebro Hospital, Ringkoebing County, Herning, Denmark
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Gustafsson C, Ekström A, Brismar S, Altman D. Urinary incontinence after hysterectomy—three-year observational study. Urology 2006; 68:769-74. [PMID: 17070350 DOI: 10.1016/j.urology.2006.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 02/28/2006] [Accepted: 04/03/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To perform a prospective evaluation of the long-term effects of hysterectomy on symptoms of urinary incontinence. METHODS A prospective observational cohort study was performed. Preoperatively, 120 consecutive patients undergoing hysterectomy for benign conditions answered a questionnaire on symptoms associated with urge and stress urinary incontinence. Of the 120 patients, 44 underwent vaginal and 76 abdominal hysterectomy. Follow-up questionnaires were administered at 1 and 3 years postoperatively. RESULTS Postoperatively, the questionnaire was answered by 115 (96%) of 120 patients after 1 year and by 107 (89%) after 3 years of follow-up. At surgery, the mean patient age was 49.5 years (range 32 to 78). In the abdominal hysterectomy cohort, a tendency was found for decreased episodes of urinary incontinence, although the difference was not significant. No significant changes were noted in micturition frequency. In the vaginal hysterectomy cohort, no significant changes were detectable in the symptoms associated with urge or stress incontinence, and no significant changes were noted in micturition frequency. For the entire hysterectomy group, a significant decrease occurred in stress urinary incontinence symptoms (P = 0.03). Subgroup analysis did not identify any particular risk factors for the development of urinary incontinence after hysterectomy. CONCLUSIONS In contrast to the results of several studies, the results of our 3-year prospective study showed that total hysterectomy, independent of route, was not associated with an increase in urge or stress urinary incontinence symptoms.
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Affiliation(s)
- Catharina Gustafsson
- Division of Obstetrics and Gynecology, Pelvic Floor Center, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Affiliation(s)
- Mikel Gray
- University of Virginia Department of Urology and School of Nursing, USA
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Abstract
Contrary to popular belief, there is now considerable evidence that simple abdominal hysterectomy does not adversely affect bladder, bowel and sexual function (collectively referred to as 'pelvic organ function'). This also appears to hold true for vaginal hysterectomy, although randomized studies are lacking. Furthermore, conservation of the cervix by performing a subtotal (supracervical) hysterectomy does not confer advantages over total hysterectomy as far as pelvic organ function is concerned. By contrast, as radical hysterectomy involves more extensive dissection of the pelvic organs and innervation, some degree of pelvic organ dysfunction might be expected. However, the small prospective studies available provide conflicting results, but major sexual problems after radical hysterectomy appear to be transient. Retrospective studies suggest that abdominal and particularly vaginal hysterectomy may predispose to vault prolapse. One study reported that subtotal hysterectomy may be associated with subsequent cervical prolapse. These issues can only be clarified when long-term follow-up of recently completed randomized trials are performed. Until then, myths regarding the most frequently performed major gynaecological operation need to be dispelled, and women requiring hysterectomy should be counselled using the best available evidence.
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Affiliation(s)
- Ranee Thakar
- Department of Obstetrics and Gynaecology, Mayday University Hospital, London Road, Croydon, Surrey CR7 7YE, UK.
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Moghaddas F, Lidfeldt J, Nerbrand C, Jernström H, Samsioe G. Prevalence of urinary incontinence in relation to self-reported depression, intake of serotonergic antidepressants, and hormone therapy in middle-aged women: a report from the Women's Health in the Lund Area study. Menopause 2005; 12:318-24. [PMID: 15879921 DOI: 10.1097/01.gme.0000143736.17715.55] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study a perceived relationship of urinary incontinence with self-reported depression among middle-aged women, and to outline whether hormone therapy, selective serotonin reuptake inhibitors, or serotonin norepinephrine reuptake inhibitors influence the prevalence of urinary incontinence. DESIGN A population-based cross-sectional study of 6,642 women from the Lund area, Sweden, aged 50 to 64 years, who answered questions on urinary incontinence. We obtained information on urinary incontinence, self-reported depression, and medication by questionnaire and personal interviews between December 1995 and February 2000. RESULTS Thirty-one percent of the women reported urinary incontinence of various severities and 52% reported episodes of depression. Urinary incontinence and self-reported depression were significantly associated [odds ratio (OR) 1.37; 95% CI, 1.23-1.52; P < 0.001]. Among women with self-reported depression, the use of serotonergic antidepressants was statistically associated with urinary incontinence (OR 1.78; 95% CI, 1.33-2.38; P < 0.001). Among women not reporting depression, hormone therapy was significantly associated with urinary incontinence (OR 1.45; 95% CI, 1.22-1.70; P < 0.001). After adjustment for other potential risk factors, serotonergic antidepressants and hormone therapy use were no longer associated with urinary incontinence in women with self-reported depression. However, among women not reporting depression, hormone therapy was still significantly more common in women with urinary incontinence. CONCLUSIONS Urinary incontinence and self-reported depression seemed to be associated in middle-aged women. Use of serotonergic antidepressants or hormone therapy does not seem to be associated with a lower prevalence of urinary incontinence.
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Affiliation(s)
- Fatemeh Moghaddas
- Department of Obstetrics and Gynaecology, Lund University Hospital, Lund, Sweden
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