Hysterectomy and Lower Urinary Tract Symptoms: A Nonrandomized Comparison of Vaginal and Abdominal Hysterectomy

Common adverse effects of hysterectomy include lower urinary tract symptoms (LUTS), especially urinary incontinence. A difference in the prevalence of LUTS between patients who have undergone vaginal and abdominal hysterectomy may be an additional factor in the choice between these 2 surgical approaches in women who need a hysterectomy. The possibility of differential effects of the 2 procedures on the development and persistence of urinary incontinence has not been well investigated. This prospective observational multicenter study compared the long-term effect of vaginal and abdominal hysterectomy on LUTS in women with benign disease. The study was conducted between 1999 and 2003 at 13 teaching hospitals in the Netherlands. The occurrence of LUTS was determined among 430 patients undergoing vaginal (n = 112) or abdominal (n = 318) hysterectomy for benign disease other than genital prolapse. Because subjective self-reporting of symptoms after surgery provides a more useful assessment than urodynamic testing, data were obtained by use of a questionnaire completed by the study subjects. Multiple logistic regression analysis was used to adjust for possible confounders. LUTS were more common at 3 years after surgery among patients who underwent vaginal hysterectomy than among those who had abdominal hysterectomy; the adjusted odds ratio was 2.2, with a 95% confidence interval of 1.3 to 4.0 after correction for differences in uteral size, descent of the uterus, and other differences. The results remained statistically significant (odds ratio: 3.0; 95% confidence interval: 1.4-6.2) after adjustment for uteral size, descent of the uterus, parity, and indication for hysterectomy. These findings show that LUTS is more common among patients who undergo vaginal hysterectomy than among those who have abdominal hysterectomy.