The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms

Objective: To study the contribution of hysterectomy to the occurrence of urge-or stress urinary incontinence symptoms. Design: A population-based, cross-sectional cohort study conducted in 1999. Setting: A university medical centre in The Netherlands. Population: Random sample of 2322 women, between 35 and 70 years of age, from a suburban area in the central part of The Netherlands. Methods: Self-report questionnaire with questions from the Urogenital Distress Inventory, sociodemographic variables and data on obstetric and gynaecological history. Main outcome measures: Multivariate logistic regression analysis was used to obtain odds ratios with 95% confidence interval of the type and bothersomeness of urinary incontinence for hysterectomy. Results: One thousand, six hundred and twenty-six women (70%) responded. The adjusted odds of urge (1.9, 1.4;2.6) and bothersome urge (2.6, 1.4;4.4) urinary incontinence were increased for women who had a hysterectomy. This association was not limited to the elderly but also occurred in women under 60 years of age. No increased odds of stress or bothersome stress incontinence were found. Conclusions: Meta-analysis has shown that hysterectomy increases the odds of urinary incontinence by 30%. However, a distinction between the different types of urinary incontinence symptoms has not been made. Such a distinction is of importance since urge incontinence gives a significantly greater reduction in health-related quality of life as compared with stress incontinence. Therefore, our finding that women scheduled for hysterectomy have an increased risk of developing urge incontinence symptoms indicates that these women should be counselled about this particular consequence.