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Am Fam Physician. 2002;66(6):1069

Hysterectomy is a common procedure most often performed to treat nonmalignant conditions such as uterine fibroids, endometriosis, abnormal bleeding, and uterine prolapse. Studies of hysterectomy and urinary incontinence have demonstrated conflicting results. Kjerulff and associates examined the effect of hysterectomy on urinary incontinence in a large, multi-center, prospective study.

Women undergoing hysterectomy for non-malignant conditions were invited to participate in the study and be interviewed at regular intervals for two years following surgery. Each participant completed a validated five-item urinary incontinence scale developed for this study. The score of the post-hysterectomy incontinence scale was subtracted from the score of the pre-hysterectomy incontinence scale to identify any change.

More than 1,000 women completed the incontinence scale before and at least once after hysterectomy. Scores on each of the five items in the incontinence scale significantly decreased after hysterectomy and remained significantly decreased during the two years of follow-up. Women who had severe urinary incontinence before hysterectomy were more likely to report improvement following the procedure, while some women who initially reported mild incontinence experienced worsening incontinence after hysterectomy. Incontinence repair concomitant with the hysterectomy, most commonly cystocele repair, significantly increased the probability of improvement.

The authors conclude that hysterectomy for nonmalignant conditions in women with moderate to severe incontinence often leads to improved incontinence for at least two years after surgery. If pre-hysterectomy incontinence is mild or nonexistent, there is a risk of worse or new-onset incontinence following hysterectomy. Although concomitant incontinence repair appears to be helpful in women with severe incontinence and protective in many women with mild or no incontinence, the outcomes are not consistent. Women having a hysterectomy can be reassured that, in most cases, incontinence symptoms will improve for at least the first two years after the procedure, but there is a 10 percent risk of worsening mild incontinence or new-onset incontinence in the first two years after hysterectomy.

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