Patient-reported lower urinary tract symptoms after hysterectomy or hysteroscopy: a study from the Swedish Quality Register for Gynecological Surgery

Lower Urinary Tract Symptoms in Uterine Myoma: A Systematic Review and Meta-Analysis

Background and Objectives: Lower urinary tract symptoms (LUTSs) are prevalent among patients with uterine myoma (UM); however, these health issues have not been systematically evaluated. To address this research gap, this systematic review and meta-analysis synthesizes existing findings on the prevalence estimates and odds ratios for LUTSs in patients with UM. Materials and Methods: A systematic literature search using PubMed and Embase was conducted for articles published between 1 January 2000 and 24 September 2023. The search and review processes followed the PRISMA and MOOSE guidelines. This study was registered in PROSPERO (CRD42023474156). Data on the prevalence and odds ratios of LUTSs-including storage symptoms (frequency, urgency, nocturia), voiding symptoms, and urinary incontinence (UI) subtypes such as stress incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI)-were extracted. Pooled prevalence estimates and odds ratios were calculated using random-effects meta-analysis. Subgroup analyses and univariate meta-regression were conducted to examine associations with age, BMI, parity, WHO region, and risk of bias. The impact of UM size was assessed using standardized mean differences. Results: Of the 572 articles screened, 20 met the inclusion criteria. The overall pooled prevalence of LUTSs in UM patients was 49% (95% CI, 26-72%), with substantial heterogeneity across studies (I2 = 99.8%). The pooled prevalence for urinary frequency, urgency, nocturia, voiding dysfunction, and overall UI, SUI, UUI, and MUI ranged from 15% to 54%. SUI and UUI were significantly associated with UM (OR = 2.0, 95% CI: 1.2-3.3; OR = 1.5, 95% CI: 1.1-2.0, respectively). Hysterectomy was not associated with an improvement in overactive bladder (OAB) symptoms (OR = 1.9, 95% CI: 0.6-5.7). A larger UM size was not linked to worsening LUTS. Fourteen studies (70%) had some concerns about the risk of bias, while six studies (30%) had a low risk of bias. Egger's test showed no significant publication bias (p = 0.19). Conclusions: Approximately half of patients with UM experience LUTSs or UI. The findings emphasize the need to consider urinary symptoms in UM management. Further research is warranted to reduce heterogeneity and explore treatment-specific outcomes.

Associations between hysterectomy and pelvic floor disorders: a systematic review and meta-analysis

OBJECTIVE

Hysterectomy is the second most common surgery performed among women in the United States. The associations between hysterectomy and the risk of pelvic floor disorders remain unclear. The objective of this study is to systematically review the associations between hysterectomy and the likelihood of pelvic floor disorders.

DATA SOURCES

A systematic search of Medline and Embase from inception to October 11, 2024, was performed without language restrictions. The systematic review was registered in The International Prospective Register of Systematic Reviews (CRD42023443210).

STUDY ELIGIBILITY CRITERIA

Studies included randomized controlled studies and nonrandomized comparative studies (that reported adjusted analyses) of adult female individuals aged ≥18 years old who underwent a hysterectomy through any route for benign indications. At least 1 year of follow-up after hysterectomy was required. Studies of individuals undergoing concomitant surgery for pelvic floor disorders were excluded.

STUDY APPRAISAL AND SYNTHESIS METHODS

Twelve investigators independently screened each abstract and potentially eligible full-text article in duplicate. Data extraction, risk of bias assessment, and strength of evidence grading were conducted using standard instruments. Meta-analyses were performed using random-effects models. Outcomes included pelvic organ prolapse, urinary incontinence (nonspecific, mixed, and stress), overactive bladder, voiding dysfunction, fecal incontinence, and defecatory dysfunction. Results were stratified by time since hysterectomy (≤10 years vs >10 years).

RESULTS

We included 60 studies (8 randomized controlled trials, 20 cohort studies, and 32 case-control studies) with 3,567,848 participants. In the first 10 years, hysterectomy was associated with higher likelihood of (nonspecific) urinary incontinence (effect size 1.29, 95% confidence interval 1.11-1.47; 25 studies), stress urinary incontinence (effect size, 1.31; 95% confidence interval, 1.06-1.56; 14 studies), overactive bladder (effect size, 1.41; 95% confidence interval, 1.25-1.58; 16 studies), and mixed urinary incontinence (effect size, 1.62; 95% confidence interval, 1.40-1.85; 3 studies). Beyond 10 years, hysterectomy was associated with higher likelihood of pelvic organ prolapse (effect size, 1.56; 95% confidence interval, 1.35-1.78; 6 studies) and stress urinary incontinence (effect size, 2.40; 95% confidence interval, 2.17-2.63; 5 studies).

CONCLUSION

Hysterectomy is associated with a statistically significant higher likelihood of urinary incontinence of all types within 10 years, as well as pelvic organ prolapse and stress urinary incontinence beyond 10 years after hysterectomy. It is important to discuss these risks at the time of counseling for hysterectomy with consideration of medical or nonhysterectomy treatment options if clinically acceptable.

Literature review, surgical decision making algorithm, and AGREE II-S comparison of national and international recommendations and guidelines in pelvic organ prolapse surgery

The average lifespan has increased over time due to improvements in quality of life, leading to an aging population that stays healthy for longer. Pelvic organ prolapse (POP), whether uterine or vaginal, is a problem that severely impairs quality of life and imposes significant restrictions. The present study provides the reader with a summary of the many surgical techniques used in POP surgery, comparing international guidelines, offering an algorithm that is simple to understand, and allows the reader to quickly choose the table that includes the best surgical therapy for each individual. Using relevant keywords, the writers searched the PubMed and Scopus databases for relevant publications from 2000 to April 2023. Studies with cases of oncologic disorders or prior hysterectomy performed for another reason were not included in the analysis. Ten distinct international guidelines are highlighted and examined in the present study. We used the Appraisal of Guidelines for Research and Evaluation II-S (AGREE II-S) method to assess their quality, and incorporated the results into the conclusion. Worldwide, anterior colporrhaphy is the preferred method of treating anterior compartment abnormalities, and mesh is virtually always used when recurrence occurs (which happens in about half of the cases). Worldwide, posterior colporrhaphy is commonly used to repair posterior compartment abnormalities. Only a few national guidelines (the Iranian guideline, Acta Obstetricia et Gynecologica Scandinavica [AOGS], and the German-speaking countries) permit the use of mesh or xenograft in cases of recurrence. There is agreement on the abdominal approach (sacrocolpopexy) with mesh for treating apical deformities. Sacrospinous-hysteropexy is the standard method used to guide the vaginal approach; mesh is typically used to aid in this process. There are just three recommendations that do not include vaginal operations: HSE, AOGS, and Iran. Of obliteration techniques, colpocleisis is unquestionably the best. In conclusion, our analysis highlights the significance of customized methods in POP surgery, taking into account the requirements and preferences of each patient. To choose the best surgical therapy, criteria and patient features must be carefully considered.

Comparative evaluation of reproductive organ-preserving versus standard radical cystectomy in female: a meta-analysis and systematic review of perioperative, oncological, and functional outcomes

BACKGROUND

To evaluate the perioperative, oncological, and functional outcomes of reproductive organ-preserving radical cystectomy (ROPRC) compared to standard radical cystectomy (SRC) in the treatment of female bladder cancer.

METHODS

A systematic search was conducted in November 2023 across several scientific databases. We executed a systematic review and cumulative meta-analysis of the primary outcomes of interest, adhering to the PRISMA and AMSTAR guidelines. The study was registered in PROSPERO (CRD42024501522).

RESULTS

The meta-analysis included 10 studies with a total of 2015 participants. ROPRC showed a significant reduction in operative time and postoperative fasting period compared to SRC (MD - 45.69, 95% CI - 78.91 ~ - 12.47, p = 0.007, and MD - 0.69, 95% CI - 1.25 ~ - 0.13, p = 0.02, respectively). Functional outcomes, both daytime continence rate (OR 4.94, 95% CI 1.53 ~ 15.91, p = 0.008) and nighttime continence rate (OR 5.91, 95% CI 1.94 ~ 18.01, p = 0.002), and sexual function measured by the Female Sexual Function Index (MD 5.72, 95% CI 0.19 ~ 11.26, p = 0.04), were significantly improved in the ROPRC group. There were no significant differences between ROPRC and SRC in terms of estimated blood loss, length of hospital stay, overall postoperative complications, minor complications or major complications. Oncologically, both procedures showed comparable outcomes with no significant differences in positive surgical margins, tumor recurrence rates, overall survival, cancer-specific survival, recurrence-free survival, or progression-free survival.

CONCLUSIONS

ROPRC is a viable and effective alternative to SRC in female bladder cancer patients, offering enhanced functional outcomes and similar oncological safety. These findings suggest that ROPRC can improve the quality of life in female bladder cancer patients without compromising the efficacy of cancer treatment.

Prevalence of Lower Urinary Tract Symptoms in Women Planning to Undergo Hysterectomy for Uterine Leiomyoma and Abnormal Uterine Bleeding

Introduction: Leiomyomas are associated with lower urinary tract symptoms (LUTS), but more specific characterization of their impact on LUTS is needed. Methods: This is a retrospective cohort study of 202 participants (101 per group) who underwent hysterectomy for leiomyomas versus abnormal uterine bleeding nonclassified (AUB-N) from July 2015 to May 2019. Baseline demographics, leiomyoma characteristics, and presence of baseline LUTS were collected. The main objective was to compare the prevalence of LUTS between these two groups. Secondary objectives were to analyze the association between leiomyoma characteristics and the prevalence of LUTS. Results: There was no difference in baseline prevalence of LUTS between the hysterectomy for leiomyoma versus AUB-N groups (42.6% vs. 45.5%, p = 0.67). When examining the entire study cohort of participants, irrespective of hysterectomy indication, leiomyoma size >6 cm was associated with an increased prevalence of LUTS when compared with leiomyoma <6 cm (64.9% vs. 40.4%, p = 0.02), and specifically difficulty passing urine (p = 0.02), nocturia (p = 0.04), and urinary frequency (p = 0.04). When controlling for age, body mass index, parity, chronic pelvic pain, and diabetes, leiomyomas >6 cm remained significantly associated with the presence of LUTS (odds ratio 3.1, 95% confidence interval = 1.2-8.3) when compared with leiomyoma <6 cm. Presence of >1 leiomyoma was associated with urinary frequency (67.9% vs. 32.1%, p = 0.02) when compared with ≤1 leiomyoma. Anterior location and uterine volume were not associated with a difference in LUTS. Conclusion: LUTS are prevalent in those planning hysterectomy for leiomyoma and AUB-N. Leiomyomas >6 cm are associated with the presence of LUTS. Future studies should evaluate change in LUTS following hysterectomy for leiomyomas.

Lower urinary tract symptoms are elevated with depression in Japanese women

OBJECTIVES

Depression might worsen lower urinary tract symptoms (LUTS), but the correlation is still disputed. This study examined the influence of depression on LUTS in Japanese women.

METHODS

This study used a web-based questionnaire to evaluate the mental status of depression and LUTS. The mental status of depression was evaluated using the Quick Inventory of Depressive Symptomatology-Japanese version (QIDS-J), and LUTS was assessed based on the Overactive Bladder Symptom Score (OABSS) and responses to the International Consultation on Incontinence Questionnaire-Short Form.

RESULTS

A total of 4151 of 5400 (76.9%) women responded to the questionnaire. The mean age was 48.3 ± 13.8 years. The OABSS gradually increased with the QIDS-J score. The incidence of overactive bladder (OAB) and urgency urinary incontinence (UUI) also increased along with the QIDS-J score. In the younger age group (20-39 years old), the risks of OAB and UUI were higher than in the elderly group (7.42 for OAB and 7.44 for UUI).

CONCLUSIONS

This study revealed that worsening of LUTS was correlated with depression.

Occupational risk factors associated with lower urinary tract symptoms among female workers: a systematic review

A systematic review was performed aiming to identify the various occupational risk factors of lower urinary tract symptoms (LUTS) among female workers. A systematic, comprehensive literature search of PubMed, Embase and Cochrane Library databases was conducted to identify studies published until 24 November 2021, evaluating the possible occupational risk factors of LUTS among female workers. Two reviewers assessed all articles retrieved through a computerised search for eligibility using predetermined criteria. Data on the first author, publication year, country, study design, participants, identified occupational risk factors, outcome variables and main results were extracted from the selected articles. The Newcastle-Ottawa Quality Assessment Scale guidelines were adopted to estimate the quality scores. Overall, our search yielded a total of 16 articles suitable for review. The occupational risk factors identified in the studies were strenuous physical demand and activity, prolonged sitting, occupational stress, shift work, limited use of the toilet at work and other occupational environments (eg, an unclean and uncomfortable workplace, dangerous job and probability of accidents, feeling pressed for time and awkward position for long periods). The findings of this review may raise awareness regarding the risk of LUTS among female workers with these factors. From an occupational health perspective, the implementation of tailored prevention strategies based on these occupational factors may prevent female workers from developing LUTS.PROSPERO registration numberCRD42022316728.

Fibroids and Urinary Symptoms Study (FUSS)

OBJECTIVE

The aims of the study were to characterize pelvic floor and urinary symptoms in women seeking treatment for uterine fibroids and to explore the association between uterine/fibroid size and pelvic floor symptoms.

METHODS

Women seeking treatment for uterine fibroids at a single academic center were enrolled in this cross-sectional study. All participants underwent pelvic imaging and completed the Symptom Severity Subscale of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) and the Pelvic Floor Distress Inventory (PFDI-20).

RESULTS

One hundred ninety-five women with a mean age of 41 ± 6 years and body mass index of 29 ± 7 kg/m2 were included. In this cohort, 58% identified as Black and 38% had at least 1 vaginal delivery. Women attributed pelvic pain (68%), dyspareunia (37%), and urinary incontinence (31%) to their fibroids. The mean ± SD UFS-QOL score was 48.7 ± 25.4, and 63% of participants reported being at least "somewhat bothered" by tightness/pressure in pelvic area, 60% by frequent daytime urination, and 47% by nocturia. The mean PFDI-20 score was 45.5 ± 31.9. Women reported being at least "somewhat bothered" by heaviness/dullness in the pelvis (60%), frequent urination (56%), pelvic pain or discomfort (48%), and sensation of incomplete bladder emptying (43%). The PFDI-20 and UFS-QOL scores were not correlated with uterine volume (r = 0.12, P = 0.12, and r = 0.06, P = 0.44) or fibroid size (r = 0.09, P = 0.26, and r = 0.01, P = 0.92).

CONCLUSIONS

Women presenting for evaluation and treatment of fibroids report high rates of pelvic floor symptoms, particularly urinary frequency and pelvic pressure. However, uterine size and fibroid size are not associated with pelvic floor symptom bother.

[Impact of hysterectomy on urinary incontinence: A systematic review]

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.

A systematic review of the prevalence, risk factors, and impact of pelvic floor dysfunctions in nurses

AIM

To investigate the prevalence, risk factors, and impact of pelvic floor dysfunctions in female nurses.

DESIGN

A systematic review.

DATA SOURCES

Searches were conducted in the following five electronic databases: PubMed/Medline, LILACS, SCIELO, Cochrane Library, and CINAHL. There were no period or language limitations.

REVIEW METHODS

Data extraction and synthesis were conducted and the appraisal of the quality of the studies was performed using the Joanna Briggs Institute critical appraisal tool checklist for prevalence data.

RESULTS

A total of 15 studies were included. The symptoms investigated were lower urinary tract symptoms, including urinary incontinence and its subtypes, sexual dysfunctions, constipation, faecal incontinence, and dual incontinence. Overall, prevalence ranged from 9.9% to 89.6%. Associated factors related to occupational roles were lifting heavy weights and poor bladder habits. Quality of life was significantly worse for nurses with pelvic floor disorders.

CONCLUSION

Pelvic floor dysfunctions are very common among female nurses, considerably affecting their quality of life. Additional studies are needed to investigate the impact on work productivity, causal relationships with the occupation and the performance of prevention and treatment interventions directed toward this population.

Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines

OBJECTIVE

We aimed to systematically review the literature on apical pelvic organ prolapse surgery with uterine preservation compared with prolapse surgeries including hysterectomy and provide evidence-based guidelines.

DATA SOURCES

The sources for our data were MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to January 2017.

STUDY ELIGIBILITY CRITERIA

We accepted randomized and nonrandomized studies of uterine-preserving prolapse surgeries compared with those involving hysterectomy.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality. If 3 or more studies compared the same surgeries and reported the same outcome, a meta-analysis was performed.

RESULTS

We screened 4467 abstracts and identified 94 eligible studies, 53 comparing uterine preservation to hysterectomy in prolapse surgery. Evidence was of moderate quality overall. Compared with hysterectomy plus mesh sacrocolpopexy, uterine preservation with sacrohysteropexy reduces mesh exposure, operative time, blood loss, and surgical cost without differences in prolapse recurrence. Compared with vaginal hysterectomy with uterosacral suspension, uterine preservation in the form of laparoscopic sacrohysteropexy improves the C point and vaginal length on the pelvic organ prolapse quantification exam, estimated blood loss, postoperative pain and functioning, and hospital stay, but open abdominal sacrohysteropexy worsens bothersome urinary symptoms, operative time, and quality of life. Transvaginal mesh hysteropexy (vs with hysterectomy) decreases mesh exposure, reoperation for mesh exposure, postoperative bleeding, and estimated blood loss and improves posterior pelvic organ prolapse quantification measurement. Transvaginal uterosacral or sacrospinous hysteropexy or the Manchester procedure compared with vaginal hysterectomy with native tissue suspension both showed improved operative time and estimated blood loss and no worsening of prolapse outcomes with uterine preservation. However, there is a significant lack of data on prolapse outcomes >3 years after surgery, the role of uterine preservation in obliterative procedures, and longer-term risk of uterine pathology after uterine preservation.

CONCLUSION

Uterine-preserving prolapse surgeries improve operating time, blood loss, and risk of mesh exposure compared with similar surgical routes with concomitant hysterectomy and do not significantly change short-term prolapse outcomes. Surgeons may offer uterine preservation as an option to appropriate women who desire this choice during apical prolapse repair.