Urinary incontinence after hysterectomy

Abstract

Jeanette Brown and colleagues (Aug 12, p 535)1Brown JS Sawaya G Thorn DH Grady D Hysterectomy and urinary incontinence: a systematic review.Lancet. 2000; 356: 535-539Summary Full Text Full Text PDF PubMed Scopus (236) Google Scholar suggest that when women are counselled about the sequelae of hysterectomy, doctors should discuss urinary incontinence as a possible long-term adverse effect. The evidence they use for systematic review is largely insufficient to support such a conclusion.The systematic review is based on 11 observational studies. Observational studies inherently risk having findings confounded by bias. Women who undergo hysterectomy differ from women who do not. Correction for differences that are associated with the incidence of urinary incontinence is mandatory for valid assessment of the association between hysterectomy and urinary incontinence. Although in two studies an attempt to correct for potential confounders was made, no analysed study succeeded in accurately correcting for all confounders.That women undergoing hysterectomy differ from those not undergoing hysterectomy is supported by the following. We compared the prevalence and impact of urinary incontinence between women undergoing hysterectomy (n=462) and non-hysterectomised women randomly selected from a population sample (n=1825) by use of the urogenital distress inventory.2Schumaker SA Wyman JF Uebersax JS et al.Health related quality of life measures for women with urinary incontinence: the urogenital distress inventory and the incontinence impact questionnaire.Qual Life Res. 1994; 3: 291-306Crossref PubMed Scopus (861) Google Scholar The results are shown in the table. Women who had had hysterectomy differed in complaints of urinary incontinence from women who had not.TableReported urinary incontinence and odds ratio for urinary incontinenceCandidate for hysterectomy (n=462)Non-candidate for hysterectomy (n=1682)Adjusted odds ratio (95% CI)*Candidates vs non-candidates, adjusted for age and parity.Urinary incontinence232 (50·2%)904 (49·5%)0·9 (0·7–1·1)Bothersome urinary incontinence142 (30·7%)143 (7·8%)5·3 (4·0–7·1)* Candidates vs non-candidates, adjusted for age and parity. Open table in a new tab Only a randomised controlled trial or an observational study that accurately adjusts for all potential confounders can validly answer the question whether hysterectomy is a risk factor for urinary incontinence. Before such a study is done, doctors should not counsel their patients about nonproven sequelae of hysterectomy. Jeanette Brown and colleagues (Aug 12, p 535)1Brown JS Sawaya G Thorn DH Grady D Hysterectomy and urinary incontinence: a systematic review.Lancet. 2000; 356: 535-539Summary Full Text Full Text PDF PubMed Scopus (236) Google Scholar suggest that when women are counselled about the sequelae of hysterectomy, doctors should discuss urinary incontinence as a possible long-term adverse effect. The evidence they use for systematic review is largely insufficient to support such a conclusion. The systematic review is based on 11 observational studies. Observational studies inherently risk having findings confounded by bias. Women who undergo hysterectomy differ from women who do not. Correction for differences that are associated with the incidence of urinary incontinence is mandatory for valid assessment of the association between hysterectomy and urinary incontinence. Although in two studies an attempt to correct for potential confounders was made, no analysed study succeeded in accurately correcting for all confounders. That women undergoing hysterectomy differ from those not undergoing hysterectomy is supported by the following. We compared the prevalence and impact of urinary incontinence between women undergoing hysterectomy (n=462) and non-hysterectomised women randomly selected from a population sample (n=1825) by use of the urogenital distress inventory.2Schumaker SA Wyman JF Uebersax JS et al.Health related quality of life measures for women with urinary incontinence: the urogenital distress inventory and the incontinence impact questionnaire.Qual Life Res. 1994; 3: 291-306Crossref PubMed Scopus (861) Google Scholar The results are shown in the table. Women who had had hysterectomy differed in complaints of urinary incontinence from women who had not. Only a randomised controlled trial or an observational study that accurately adjusts for all potential confounders can validly answer the question whether hysterectomy is a risk factor for urinary incontinence. Before such a study is done, doctors should not counsel their patients about nonproven sequelae of hysterectomy. Urinary incontinence after hysterectomyAuthor's reply Full-Text PDF