Prevalence of urinary incontinence and prolapse after hysterectomy for benign disease versus gynecologic malignancy
Abstract
Objectives: To estimate the prevalence of UI and POP after hysterectomy for benign disease and gynecologic malignancy. This is a retrospective cohort chart review study. Two major urban tertiary care centers between 2006–2010. Women ≥ 18 years undergoing hysterectomy for benign or malignant indications.
Material and methods: Presence of UI and POP was based on patient report in clinic notes, ICD-9 UI and POP diagnosis codes, and CPT codes for treatment. Prevalence of UI and POP after hysterectomy and time to development of UI and POP after hysterectomy.
Results: 1363 (55%) women underwent hysterectomy for benign disease while 1107 (45%) had a hysterectomy for malignancy. Postoperative prevalence of UI and POP in the benign versus the malignant group was 15.1% vs 11.1% (p = 0.001), and 12.1% vs 2.8%, (p < 0.001), respectively. The median time to development of UI in the subset of patients without preoperative UI was 3.5 years in the benign group vs 3 years in the malignant group (p < 0.001). The median time to development of POP in the subset of patients without preoperative POP was 5 years in the benign group and 3.5 years in the malignant group (p < 0.001). There was no significant difference in the risk of developing UI or POP between groups after adjusting for confounders or when accounting for pre-hysterectomy UI or POP.
Conclusions: When pre-hysterectomy UI or POP is taken into consideration, there is no difference in the prevalence of post-hysterectomy UI or POP.
Keywords: benign diseasegynecologic cancerhysterectomypelvic organ prolapseprevalenceurinary incontinence
References
- Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014; 123(1): 141–148.
- Andersen LL, Møller LM, Gimbel H, et al. Danish Hysterectomy Trial Group. Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy: exploratory analyses from a randomized clinical trial with a 14-year follow-up. Int Urogynecol J. 2015; 26(12): 1767–1772.
- Lakeman MME, van der Vaart CH, Roovers JP, et al. HysVA study group. Hysterectomy and lower urinary tract symptoms: a nonrandomized comparison of vaginal and abdominal hysterectomy. Gynecol Obstet Invest. 2010; 70(2): 100–106.
- Farquhar CM, Sadler L, Stewart AW. A prospective study of outcomes five years after hysterectomy in premenopausal women. Aust N Z J Obstet Gynaecol. 2008; 48(5): 510–516.
- Persson P, Brynhildsen J, Kjølhede P, et al. Hysterectomy Multicentre Study Group in South-East Sweden. Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study. BJOG. 2013; 120(12): 1556–1565.
- Altman D, Falconer C, Cnattingius S, et al. Pelvic organ prolapse surgery following hysterectomy on benign indications. Am J Obstet Gynecol. 2008; 198(5): 572.e1–572.e6.
- Gabriel I, Kalousdian A, Brito LG, et al. Pelvic organ prolapse after 3 modes of hysterectomy: long-term follow-up. Am J Obstet Gynecol. 2021; 224(5): 496.e1–496.e10.
- Selcuk S, Cam C, Asoglu MR, et al. Effect of simple and radical hysterectomy on quality of life - analysis of all aspects of pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol. 2016; 198: 84–88.
- Cibula D, Velechovska P, Sláma J, et al. Late morbidity following nerve-sparing radical hysterectomy. Gynecol Oncol. 2010; 116(3): 506–511.
- Laterza RM, Salvatore S, Ghezzi F, et al. Urinary and anal dysfunction after laparoscopic versus laparotomic radical hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2015; 194: 11–16.
- Thomas SG, Sato HRN, Glantz JC, et al. Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients. Obstet Gynecol. 2013; 122(5): 976–980.
- Ramaseshan AS, Felton J, Roque D, et al. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. Int Urogynecol J. 2018; 29(4): 459–476.
- Wojcik M, Jarzabek-Bielecka G, Merks P, et al. The role of visceral therapy, Kegel's muscle, core stability and diet in pelvic support disorders and urinary incontinence - including sexological aspects and the role of physiotherapy and osteopathy. Ginekol Pol. 2022; 93(12): 1018–1027.
- Christiansen UJ, Hansen MJ, Lauszus FF. Hysterectomy is not associated with de-novo urinary incontinence: A ten-year cohort study. Eur J Obstet Gynecol Reprod Biol. 2017; 215: 175–179.
- Bohlin KS, Ankardal M, Lindkvist H, et al. Factors influencing the incidence and remission of urinary incontinence after hysterectomy. Am J Obstet Gynecol. 2017; 216(1): 53.e1–53.e9.
- Wang S, Wang R, Wen H, et al. Association of pelvic floor function with postoperative urinary incontinence in cervical cancer patients after the radical hysterectomy. Neurourol Urodyn. 2021; 40(1): 483–492.
- Nakayama N, Tsuji T, Aoyama M, et al. Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey. BMC Womens Health. 2020; 20(1): 148.
- Higgs P, Janda M, Asher R, et al. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer. Am J Obstet Gynecol. 2018; 218(4): 419.e1–419.e14.