More than 600,000 hysterectomies are performed in the United States every year, and more than 40 percent of American women who are 60 years of age have had a hysterectomy. Although most hysterectomies are performed for treatment of benign disorders, the procedure is associated with serious complications in about 10 percent of cases and a mortality rate of six per 10,000 operations. Fewer data are available concerning long-term complications. Because hysterectomy may damage the nerves and support tissues of the pelvis, urinary incontinence can develop. Brown and colleagues studied the relationship between hysterectomy and subsequent development of urinary incontinence.
They searched electronic databases and article references for pertinent data and consulted with experts on the topic to identify relevant studies. All studies were reviewed for quality by two experts. Forty-five articles were discovered, but only 12 met the authors' quality criteria. These studies varied in design, inclusion criteria and duration of follow-up. From 11 observational studies, the authors calculated that women who had undergone hysterectomy had a 40 percent increased risk of urinary incontinence. In women 60 years and older, the prevalence of urinary incontinence was 40 to 80 percent higher in those who had a hysterectomy. Individual studies were found linking hysterectomy to each of the three major types of incontinence—urge, stress and mixed.
The authors conclude that hysterectomy substantially increases the risk of developing urinary incontinence. The relationship of previous hysterectomy to urinary incontinence increases with age, and the incidence may be more than 60 percent in women who are 60 years or older. They advocate that all women considering hysterectomy be counseled about the risk of developing urinary incontinence later in life.