26 October 2007

Hysterectomy, incontinence linked

Women who undergo hysterectomies for benign conditions more than double their risk of needing subsequent surgery for stress urinary incontinence, a new study finds.

Women who undergo hysterectomies for benign conditions more than double their risk of needing subsequent surgery for stress urinary incontinence, a new study finds.

This was true regardless of what type of surgical technique was used for the hysterectomy, the researchers noted.

The article is published in the Oct. 27 issue of The Lancet, and although the study contradicts previous research, some experts said they are inclined to believe the current study.

"The authors have a lot of experience from previous studies, and they conducted this study using a very tight registry in Sweden. They had the opportunity to analyse the data almost in a unique way," noted Dr. Gil Levy, director of urogynecology at the Pelvic Floor Dysfunction and Reconstructive Surgery Centre at Maimonides Medical Centre in New York City. "When they come up with these results, it should be taken very seriously," he said.

According to background information in the study, many women opt to have a hysterectomy, because it can cure irregular heavy menstrual bleeding, uterine prolapse and postmenopausal bleeding. One in five British women will have undergone a hysterectomy by the time they reach 55. In the United States, 600 000 hysterectomies are performed each year, 90 percent of them for a benign indication (as opposed to cancer).

Studies regarding how a hysterectomy might affect lower-urinary-tract function have been inconsistent, however.

40% of women suffer from incontinence
Female stress urinary incontinence is defined as involuntary leakage of urine upon effort or exertion. About 40 percent of women in most industrialized countries have the condition, with considerable effect on daily function as well as sexuality and psychological well-being.

This 30-year study, conducted between 1973 and 2003, involved more than 165,000 Swedish women who had undergone a hysterectomy and more than 479,500 women who had not.

The risk of having to undergo surgery for stress urinary incontinence was 2.4 times higher in the hysterectomy group than in the control group, regardless of what type of surgical technique was used for the hysterectomy.

The highest risk was during the first five years after the hysterectomy, when the risk was 2.7 times higher.

The lowest risk was more than 10 years down the line, when the risk was only 2.1 times higher for patients who had undergone a hysterectomy compared with those who had not.

Surgical trauma to blame
The most logical explanation for the association, according to the authors, was surgical trauma that can occur when the uterus and cervix are detached from the pelvic-floor supportive tissues during a hysterectomy.

"This is a big, well done and population-based study," noted one outside expert, Dr. Tristi Wood Muir, assistant professor of obstetrics and gynaecology, Texas A&M Health Science Centre College of Medicine and director of female pelvic medicine and reconstructive surgery for Scott & White in Temple. "Certainly, the uterus and bladder are intimately related, and, certainly, dissecting the bladder off can cause problems down the road. When we do a hysterectomy, we have to re-establish support, and it may be that a lack of support is causing the stress urinary incontinence. But it could also be a whole host of other reasons. It could be any number of things."

According to the accompanying comment article, several other reasons might explain the incidence of stress urinary incontinence, some of which might have nothing to do with the hysterectomy.

Regardless of the cause, most of the experts agreed that hysterectomy is not something to be undertaken lightly.

"With any sort of surgical intervention, there are possible risks and side effects, and the way the body tissues and nerves react to incisions and stitches is quite variable between patients," said Dr. Jennifer Wu, an obstetrician/gynaecologist at Lenox Hill Hospital in New York City. "This is something to consider when patients are thinking about surgery like a hysterectomy for a benign indication. There will always be some sort of need for hysterectomy whether it's for cancer or for severe bleeding or severe pain, but patients need to realize that while it can cure some problems, it can also be the source of other problems, so it is something patients will need to talk about with their doctors." - (Amanda Gardner/HealthDay News)

Read more:
Incontinence ops weighed up
Hysterectomy toss-up




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