Hysterectomy Raises Risk Of Incontinence Surgery, New Study

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Main Category: Women's Health / Gynecology
Also Included In: Urology / Nephrology
Article Date: 29 Oct 2007 - 2:00 PDT

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A new 30 year Swedish study has found that women who have had a hysterectomy to treat non-life threatening conditions have a higher risk later in life of getting urinary incontinence that needs surgery to correct it.

The study is published in the 27th October issue of The Lancet and is the work of Dr Daniel Altman of the Karolinska Institutet Danderyd Hospital, Stockholm, and colleagues.

The risk is even higher for women who have given birth to more than one child vaginally, said the researchers.

Altman and colleagues conducted a nationwide population-based, observational cohort study from 1973 to 2003 of women in Sweden. They enrolled 165,260 women who had had a hysterectomy and 479,506 women who had not. The two groups were matched by age and where they lived.

The researchers used the Swedish Inpatient Registry to find out how many women in each group had had stress-urinary-incontinence surgery (SUIS) and ran statistical tests comparing the two groups.

The results showed that over the 30 years, the rate of SUIS per 100,000 person-years was 179 in the group that had had hysterectomy compared with 76 in the group that had not.

The increased risk of SUIS among the women who had had a hysterectomy was calculated to be 2.4 times higher compared to the group that had not. This risk was independent of the surgery technique.

The risk for SUIS varied slightly with time of follow up, the researchers wrote. The highest overall risk was found to occur within 5 years of surgery (2.7 times) and the lowest risk was found to occur after an observation period of 10 years or more (2.1 times).

Altman and colleagues concluded that:

" Hysterectomy for benign indications, irrespective of surgical technique, increases the risk for subsequent stress-urinary-incontinence surgery."

They recommended that women considering undergoing hysterectomy for benign reasons should be counselled about the risks and be helped to consider other treatment options.

A hysterectomy is an operation that removes all or part of the body and cervix of the uterus and is usually performed to remove cancerous tumours, because of postmenopausal bleeding, or prolapse of the uterus, as well as other reasons.

According to the National Women's Health Information Center, which is part of the US Department of Health and Human Services, hysterectomy is the second most common surgery among women in the US, the most common being delivery by cesarean section.

According to the Center, hysterectomy may be the only option to treat cancer, but depending on condition, other treatment options include: drug therapy, endometrial ablation, uterine artery embolization, myomectomy, and having a vaginal pessary inserted.

More than 600,000 hysterectomies are carried in the US every year, and one in three American women has had a hysterectomy by the age of 60.

"Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study."
Daniel Altman, Fredrik Granath, Sven Cnattingius, and Christian Falconer.
The Lancet 2007; 370:1494-1499.
Volume 370, Number 9597, 27 October 2007.
DOI:10.1016/S0140-6736(07)61635-3

Click here for Abstract.

Click here for more information on hysterectomy from the National Women's Health Information Center.

Written by: Catharine Paddock
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