Presented by: Jun Ho Lee MD,PhD
Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea

Introduction

We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI).

Materials

We used national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011, and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. Propensity score matching (PSM, 1:1) was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a SUI diagnosis code.

Results

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After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.8 years in the controls and 7.9 years in the cases. The rate of anti-incontinence surgery was modest but significantly higher in the cases than in the controls (1.7% vs. 2.0%; P<0.001). Compared to the rate in the controls, abdominal hysterectomy significantly increased the rate of anti-incontinence surgery before (HR (95% CI): 1.235 (1.116-1.365)) and after adjusting for confounders (HR (95% CI): 1.215 (1.097-1.347)). However, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery did not increase anti-incontinence surgery rates compared to those in the controls. This significant relationship between abdominal hysterectomy and anti-incontinence surgery was maintained after stratifying patients according to age group.

Conclusion

Patients who plan to undergo transabdominal hysterectomy for the treatment of uterine fibroids should be counseled about the risk of SUI, especially the risk of anti-incontinence surgery.

Funding

None

Lead Authors

Dong-Gi Lee, MD,PHD
Department of Urology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine

Gyeong Eun Min, MD,PHD
Department of Urology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine

Hyung-Lae Lee, MD,PH
Department of Urology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine

Kyung Jin Chung, MD,PHD
Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine