Changes in incontinence after hysterectomy

Low trunk muscle mass could predict severe stress urinary incontinence in Asian women

AIM

Adequate pelvic floor support for the urethra is crucial for preventing stress urinary incontinence (SUI). Obesity is an established risk factor for SUI. This study aimed to explore the relationship between SUI and body composition, specifically focusing on muscle and fat mass.

METHODS

This single-center, prospective, cross-sectional study enrolled women who visited the genitourinary clinic of Taipei City Hospital-Zhongxiao Branch between 1 February 2020 and 31 January 2021. SUI severity was classified according to the type of daily activity in which SUI occurred. Potential risk factors for SUI, including age, labor and history of hysterectomy, were also included. All participants underwent a bioelectric impedance analysis of their body composition. Independent t-tests and Pearson's χ2-tests were used to compare the differences in continuous and categorical parameters between groups. Logistic regression analysis was used to characterize the predictive value of body composition for severe SUI.

RESULTS

Of the 256 included patients, 37 had severe SUI. The participants with severe SUI were older and were more likely to have undergone a hysterectomy. They also had a considerably higher prevalence of sarcopenia. In the univariate analysis, a sarcopenia diagnosis was associated with severe SUI. Furthermore, a history of hysterectomy correlated with severe SUI, although with borderline significance. In the multivariate analysis, a history of hysterectomy and lower trunk muscle mass index were found to be independent predictors of severe SUI.

CONCLUSIONS

A history of hysterectomy and a lower trunk muscle mass index are correlated with severe SUI. Geriatr Gerontol Int 2025; 25: 226-231.

Hysterectomy is not associated with increased risk of urinary incontinence-a northern Finland birth cohort 1966 study

INTRODUCTION

Hysterectomy has been suggested to increase the risk of urinary incontinence (UI), although evidence is controversial. In our population-based cohort study, we aimed to assess the independent effect of hysterectomy on the risk of de novo UI.

MATERIAL AND METHODS

This is a population-based cohort study on the women of the Northern Finland Birth Cohort 1966 (n = 5889). We identified all hysterectomies among the cohort (n = 461) using the national Care Register for Health Care and classified them according to surgical approach into laparoscopic (n = 247), vaginal (n = 107), and abdominal hysterectomies (n = 107). Women without hysterectomy formed the reference group (n = 3495). All women with UI diagnoses and operations were identified in the register, and women with preoperative UI diagnosis (n = 36) were excluded from the analysis to assess de novo UI. Data on potential confounding factors were collected from registers and the cohort questionnaire. Incidences of different UI subtypes and UI operations were compared between the hysterectomy and the reference groups, and further disaggregated by different hysterectomy approaches. Logistic regression models were used to analyze the association between hysterectomy and UI, with adjustments for several UI-related covariates.

RESULTS

We found no significant difference in the incidence of UI diagnoses or the rate of subsequent UI operations between the hysterectomy and the reference groups (24 [5.6%] vs. 166 [4.7%], p = 0.416 and 14 [3.3%] vs. 87 [2.5%], p = 0.323). Hysterectomy was not significantly associated with the risk of any subtype of UI (overall UI: OR 1.20, 95% CI 0.77-1.86; stress UI (SUI): OR 1.51, 95% CI 0.89-2.55; other UI: OR 0.80, 95% CI 0.36-1.74). After adjusting for preoperative pelvic organ prolapse (POP) diagnoses, the risk was decreased (overall UI: OR 0.54, 95% CI 0.32-0.90; other than SUI: OR 0.40, 95% CI 0.17-0.95). Regarding different hysterectomy approaches, the risks of overall UI and SUI were significantly increased in vaginal, but not in laparoscopic or abdominal hysterectomy. However, adjusting for preoperative POP diagnosis abolished these risks.

CONCLUSIONS

Hysterectomy is not an independent risk factor for de novo UI. Instead, underlying POP appears to be a significant risk factor for the incidence of UI after hysterectomy.

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

Purpose

Hysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse.

Methods

We included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9–14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence.

Results

The re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03).

Conclusion

Hysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.