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Archives of Gynecology and Obstetrics

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01-10-2017 | General Gynecology

Changes in incontinence after hysterectomy

Authors: Anne Raabjerg Kruse, Trine Dalsgaard Jensen, Finn Friis Lauszus, Ervin Kallfa, Mogens Rørbæk Madsen

Published in: Archives of Gynecology and Obstetrics | Issue 4/2017

Abstract

Purpose

Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy.

Methods

108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively.

Results

In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p < 0.01) and urge incontinence with age (r = 0.24, p < 0.02). Further, improvement after hysterectomy in stress incontinence was associated with younger age (r = 0.20, p < 0.04). Improvement in urge incontinence was positively associated with BMI (r = 0.22, p = 0.02). A slight but significant loss was seen in lean body mass 13 and 30 days postoperatively.

Conclusions

Hysterectomy was not significantly associated with the risk of incontinence; in particular, when no further vaginal surgery is performed. Hysterectomy may even have a slightly positive effect on incontinence and de-novo cure.

Christensen T, Kehlet H (1993) Postoperative fatigue. World J Surg 17(2):220–225CrossRefPubMed

Jensen MB, Houborg KB, Norager CB, Henriksen MG, Laurberg S (2011) Postoperative changes in fatigue, physical function and body composition: an analysis of the amalgamated data from five randomized trials on patients undergoing colorectal surgery. Colorectal Dis 13(5):588–593. doi:10.1111/j.1463-1318.2010.02232.x CrossRefPubMed

Christensen T, Bendix T, Kehlet H (1982) Fatigue and cardiorespiratory function following abdominal surgery. Br J Surg 69(7):417–419. doi:10.1002/bjs.1800690721 CrossRefPubMed

Edwards H, Rose EA, King TC (1982) Postoperative deterioration in muscular function. Arch Surg 117(7):899–901. doi:10.1001/archsurg.1982.01380310021005 CrossRefPubMed

Wilmore DW (2002) From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg 236(5):643–648. doi:10.1097/01.SLA.0000032942.79841.ED CrossRefPubMedPubMedCentral

Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198. doi:10.1097/SLA.0b013e31817f2c1a CrossRefPubMed

Vlug MS, Wind J, van der Zaag E et al (2009) Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme. Colorectal Dis 11(4):335–343. doi:10.1111/j.1463-1318.2008.01679.x CrossRefPubMed

Li MZ, Xiao LB, Wu WH et al (2012) Meta-analysis of laparoscopic versus open colorectal surgery within fast-track perioperative care. Dis Colon Rectum 55(7):821–827. doi:10.1097/DCR.0b013e31824bd31e CrossRefPubMed

Andersen LL, Ottesen B, Alling Møller LM et al, Danish Hysterectomy Trial Group (2015) Subtotal versus total abdominal hysterectomy: randomized clinical trial with 14-year questionnaire follow-up. Am J Obstet Gynecol 212:758.e1–758.e54. doi:10.1016/j.ajog.2014.12.039

10.

Lethaby A, Ivanova V, Johnson NP (2006) Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database Syst Rev 2:CD004993. doi:10.1002/14651858.CD004993.pub2

11.

Chiarelli P, Cockburn J (2002) Promoting urinary continence in women after delivery: randomised controlled trial. BMJ 324(7348):1241CrossRefPubMedPubMedCentral

12.

Lauszus FF, Kallfa E, Madsen MR (2016) Fatigue and physical performance after hysterectomy measured by SF-36, ergometer, and dynamometer. Arch Obstet Gynecol. doi:10.1007/s00404-015-3999-0

13.

http://dugabase.dk/indberetning/registreringsskemaer/. Accessed 29 May 2017; the Danish version of the ICIQ-UI SF questionnaire in English at www.ics.org

14.

Avery K, Donovan J, Peters T, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330. doi:10.1002/nau.20041 CrossRefPubMed

15.

Bjorner JB, Damsgaard MT, Watt T et al (1998) Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol 51(11):1001–1011. doi:10.1016/S0895-4356(98)00092-4 CrossRefPubMed

16.

Jensen MB, Nørager CB, Sommer T et al (2014) Changes in fatigue and physical function following laparoscopic colonic surgery. Polski Przeglad Chirurgiczny 86:82–88. doi:10.2478/pjs-2014-0015 CrossRefPubMed

17.

Humalajärvi N, Aukee P, Kairaluoma MV et al (2014) Quality of life and pelvic floor dysfunction symptoms after hysterectomy with or without pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 182:16–21. doi:10.1016/j.ejogrb.2014.08.032 CrossRefPubMed

18.

Kjerulff KH, Langenberg PW, Greenaway L et al (2002) Urinary incontinence and hysterectomy in a large prospective cohort study in American women. J Urol 167(5):2088–2092. doi:10.1016/S0022-5347(05)65091-4 CrossRefPubMed

19.

Engh MA, Otterlind L, Stjerndahl JH et al (2006) Hysterectomy and incontinence: a study from the Swedish national register for gynecological surgery. Acta Obstet Gynecol Scand 85(5):614–618. doi:10.1080/00016340600555942 CrossRefPubMed

20.

Reitsma ML, Vandenkerkhof EG, Johnston SL et al (2011) Does health-related quality of life improve in women following gynaecological surgery? J Obstet Gynaecol Can 33:1241–1247. doi:10.1016/S1701-2163(16)35109-X CrossRefPubMed

21.

Trochez R, Harber P, Holmes D (2012) Is postal postoperative follow-up in urogynaecology feasible? J Obstet Gynaecol 32(7):663–665. doi:10.3109/01443615.2012.713051 CrossRefPubMed

22.

Gimbel H, Zobbe V, Andersen BJ et al (2005) Lower urinary tract symptoms after total and subtotal hysterectomy: results of a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 16(4):257–262. doi:10.1007/s00192-005-1291-8 CrossRefPubMed

23.

Rock JA (2001) Quality-of-life assessment in gynecologic surgery. J Reprod Med 46(5 Suppl):515–519PubMed

24.

Katsara A, Wight E, Heinzelmann-Schwarz V, Kavvadias T (2016) Long-term quality of life, satisfaction, pelvic floor symptoms and regret after colpocleisis. Arch Gynecol Obstet 294(5):999–1003. doi:10.1007/s00404-016-4158-y CrossRefPubMed

25.

Fanfani F, Costantini B, Mascilini F, Vizzielli G, Gallotta V, Vigliotta M, Piccione E, Scambia G, Fagotti A (2015) Early postoperative bladder training in patients submitted to radical hysterectomy: is it still necessary? A randomized trial. Arch Gynecol Obstet 291(4):883–888. doi:10.1007/s00404-014-3500-5 CrossRefPubMed

26.

Vierhout ME (2001) Influence of nonradical hysterectomy on the function of the lower urinary tract. Obstet Gynecol Surv 56:381–386CrossRefPubMed

27.

Einarsson JI, Suzuki Y, Vellinga TT et al (2011) Prospective evaluation of quality of life in total versus supracervical laparoscopic hysterectomy. J Minim Invasiv Gynecol 18(5):617–621. doi:10.1016/j.jmig.2011.06.003 CrossRef

28.

Neumann GA, Lauszus FF, Ljungstrøm B et al (2007) Incidence and remission of urinary incontinence after hysterectomy—a 3-year follow-up study. Int Urogyn J 18:379–382. doi:10.1007/s00192-006-0160-4 CrossRef

29.

Townsend MK, Danforth KN, Rosner B et al (2008) Physical activity and incident urinary incontinence in middle-aged women. J Urol 179:1012–1016. doi:10.1016/j.juro.2007.10.058 (discussion 1016-7) CrossRefPubMedPubMedCentral

30.

Learman LA, Summitt RL Jr, Varner RE et al (2003) Total or Supracervical Hysterectomy (TOSH) Research Group. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol 102(3):453–462PubMed

31.

Samuelsson EC, Victor FT, Svardsudd KF (2000) Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old. Am J Obstet Gynecol 183(3):568–574. doi:10.1067/mob.2000.106763 CrossRefPubMed

32.

Hunt DR, Rowlands BJ, Johnston D (1985) Hand grip strength—a simple prognostic indicator in surgical patients. J Parenter Enteral Nutr 9(6):701–704CrossRef

33.

Krogh RA, Neumann GA, Lauszus FF et al (2007) Hysterectomy is associated to stress incontinence in women, who previously had a transcervical endometrial resection. Gynecol Obstet Invest 63:121–125. doi:10.1159/000096433 CrossRefPubMed

Title: Changes in incontinence after hysterectomy
Authors: Anne Raabjerg Kruse
Trine Dalsgaard Jensen
Finn Friis Lauszus
Ervin Kallfa
Mogens Rørbæk Madsen
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2017
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4481-y

At a glance: The STEP trials

Springer Medicine

Changes in incontinence after hysterectomy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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