Hysterectomy Patients Much More Prone To Need Stress Urinary Incontinence Surgery

A woman who has a hysterectomy for benign indications runs double the chances of needing stress urinary incontinence surgery (SUIS) later on. Benign indications means those which do not lead to life-threatening conditions, such as cancer. You can read about this in the medical journal The Lancet.The authors believe women should receive counseling on the risks linked to hysterectomy - other treatment options should be considered before surgery takes place. An Accompanying Comment explains how the Article contradicts previous studies which had been written by the same authors. The Comment concludes that there might be other reasons why the risk is raised. Uterenie prolapse, irregular and heavy menstrual bleeding, postmenopausal bleeding, among others conditions, are reasons why a woman may choose to have a hysterectomy. About 20% of 55-year-old British women have had a hysterectomy. Dr Daniel Altman, Danderyd University Hospital, Stockholm, Sweden, and carried out a 30-year study of 165,260 Swedish women who had undergone hysterectomy (exposed group) - the study covered the period 1973-2003. They were compared to 479,506 Swedish women who had not undergone the surgical procedure (unexposed group). They were matched by age and area of residence. Incidence of SUIS in both groups was established from the Swedish Inpatient Registry. The risk of undergoing SUIS was 2.4 times higher for women in the exposed group compared to the unexposed group, explained the scientists. This was irrespective of surgical technique. In general, the first five years brought with them the highest risk - during which the exposed group women had a 2.7 times higher SUIS risk. Over ten years after hysterectomy the risk was 2.1 times higher for the exposed group. "The most biologically plausible rationale for this association is surgical trauma caused when the uterus and cervix are severed from pelvic-floor supportive tissues at the time of hysterectomy. Hysterectomy could interfere with the intricate urethral sphincter mechanism...it might also result in changes of urethral and bladder neck support. We conclude that hysterectomy, irrespective of surgical technique, increases the risk for stress-urinary-incontinence surgery later in life, with multiparous** women at particular risk. Our findings have important public-health and clinical applications, in view of the many women undergoing hysterectomy for benign indications," the authors write. (**Multiparous women are women who have given birth to more than one child vaginally, i.e. not through caesarean section.)"So, what is the truth? It seems likely that a simple hysterectomy does not adversely affect bladder function, at least initially, and indeed pre-existing symptoms may improve. If hysterectomy-induced urinary stress incontinence is a reality, it only becomes so several years after the surgery, as already suggested. Or perhaps it has nothing to do with hysterectomy, and women who agree to hysterectomy are just different in ways that we do not yet understand," writes Dr Adam Magos, Royal Free Hospital, London, UK, in an Accompanying Comment. http://www.thelancet.com