How is the lower urinary tract affected by gynaecological surgery?

Abstract

Prospective longitudinal studies where LUTS are evaluated before and after hysterectomy with a questionnaire should help to eliminate bias. In 209 patients undergoing abdominal hysterectomy and supravaginal amputation, 10% had preoperative nocturia and dysuria, which was unchanged when assessed a year after surgery, suggesting little effect of surgery. In a separate study, 57% of women complained of LUTS before the procedure, which was significantly reduced by the intervention of hysterectomy [5,6], whereas an increase from 58% to 75% of patients with troublesome LUTS after hysterectomy was reported in another study [7]. Analysis of symptom questionnaires can be criticised because they are subjective; they depend on the reliability and validity of the questionnaire. There are many potential reasons to explain the discrepancy between different studies. Hysterectomy is a common operation and LUTS increase with age. The prevalence of both these conditions is high and may explain their apparent association. Common findings in patients after undergoing hysterectomy are haematoma, oedema and minor trauma to the bladder or urethra, possibly explaining the short duration of symptoms. Patients may often associate the onset of LUTS with the hysterectomy, as they remember a specific event such as an operation.