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Incontinencia Urinaria
Incontinencia Urinaria
Abstract
Objective: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy.
Study design: One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001,
answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a
conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001.
Results: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups.
Mean follow-up was 4.6 2.2 years (range 1.5–11) after vaginal hysterectomy and 4 1.8 years (range 1.5–7) after conservative treatment.
The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups.
Conclusion: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared
with conservative treatment.
# 2006 Elsevier Ireland Ltd. All rights reserved.
0301-2115/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ejogrb.2006.01.032
R. de Tayrac et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 130 (2007) 258–261 259
During that 11-years period, we have performed hysterectomy for menorrhagia and the 116 women who had
vaginal hysterectomies according to Peham-Amreich a history of conservative treatment with uterine balloon
technique, modified by Centaro and expanded by Dargent therapy.
[9], with a suture of the uterosacral ligaments to the vaginal
angles, in order to prevent a post-hysterectomy vaginal
vault prolapse. 4. Statistical analysis
These 717 women were invited to participate in a study
on the prevalence of urogenital symptoms. All women Analysis of categorical variables was by the x-square
received a questionnaire with an accompanying letter test and Fisher’s exact test when numbers were small.
explaining the purpose of the study. Care was taken to Continuous variables with a normal distribution were
encourage women without any symptoms to participate, analysed using Student’s t-test and ordinal data by the
emphasising the importance of comparing their situation Mann–Whitney U-test. p < 0.05 was considered statistically
with women with symptoms. Four hundred and forty-nine significant. The data are summarized as the mean S.D.
women who did not respond, received a reminding letter or the percentage according to the variables.
after 3 months. Three hundred and sixty-five questionnaires
were returned (50.9%). Fifty-one women were excluded for
the analysis, because they reported urinary symptoms before 5. Results
the operation, leaving 314 fully evaluable women. In this
sample, 197 women had a vaginal hysterectomy for pelvic Table 1 shows the characteristics of the vaginal
pain (62.7%) and 117 for menorrhagia (37.3%), including 94 hysterectomy and uterine balloon therapy groups. Mean
menorrhagia due to uterine fibroids and 23 dysfunctional age, mean parity, menopausal status, smoking status, drink
uterine bleeding. habits were similar in the two groups, and none woman had
history of urogenital symptoms before their operation.
Mean follow-up after the operation was 4.6 2.2 years
3. Measurements (range 1.5–11) for the vaginal hysterectomy group and
4 1.8 years (range 1.5–7) for the uterine balloon therapy
All women received a self-report questionnaire in 2002. group.
The questionnaire consists of 47 items about urogenital Table 2 shows the prevalence of the different types of
symptoms, defaecatory symptoms and sexual problems. For urinary symptoms, including urinary incontinence, among
the present study we used the data from the following items: women with and women without a history of vaginal
age, parity, menopausal status (yes/no), smoking status (yes/ hysterectomy. Statistical analysis for each urinary symptom
no), volume of drink per day (less/more than 2 L of water), for women with a history of vaginal hysterectomy reveals
frequency (more than eight micturitions per day), nocturia none difference for women without a history of vaginal
(more than one micturition per night), urgency (never/every hysterectomy. Since follow-up is considered to be an
month/every week/every day), urinary incontinence (yes/ important modifier of the effect of hysterectomy on urinary
no), use of pads (yes/no), urge incontinence (never/every incontinence, a separate analysis was performed for follow-
month/every week/every day), stress incontinence (never/ up <5 years and 5 years (Table 3). Again, separate analysis
every month/every week/every day) and voiding difficulties for each urinary symptom, for follow-up less and more than
(never/every month/every week/every day). Every question 5 years from the operation, reveals none difference between
on urinary symptoms was disease-specific and has been woman with and women without a history of vaginal
validated in French in the MHU (Mesure du Handicap hysterectomy.
Urinaire) scale.
In order to compare the results of these questionnaires to
a control group, we have sent the same questionnaire to 203
patients who had a history of conservative treatment for Table 1
dysfunctional uterine bleeding with the uterine balloon Characteristics of the vaginal hysterectomy (VH) and uterine balloon
therapy (control) groups
therapy (ThermachoiceTM, Gynecare, Ethicon, 1 rue
Camille Desmoulin, Issy-les-Moulineaux, France), in our VH group Control group p Value
n = 117 n = 116
Department from January 1994 to December 2001. That
procedure is incapable of compromising bladder function or Age (years) 51.4 [42–66] 50.9 [39–61] NS
Parity 2.1 [1–3] 2.2 [1–4] NS
involving any disturbance to the pelvic floor. One hundred Menopausal status 51 (43.5) 55 (47.4) NS
and sixteen questionnaires were returned (57.1%), none Smoking status 21 (17.9) 20 (17.2) NS
woman had urogenital symptoms before uterine balloon Drink >2 L/day 9 (7.7) (9.5) NS
therapy and all were fully evaluable. History of urogenital 0 0 NS
Overall, for the present study, we have chosen to compare symptoms
for urinary symptoms, the 117 women who had a history of Values are given as mean [range] or numbers (%); NS: not significant.
260 R. de Tayrac et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 130 (2007) 258–261
Table 3
Prevalence of urinary incontinence among women with (VH) and without (control) a history of vaginal hysterectomy, according to follow-up
Follow-up < 5 years Follow-up 5 years
VH group n = 62 Control group n = 81 p Value VH group n = 55 Control group n = 35 p Value
Urinary incontinence (overall) 28 (45.2) 31 (38.3) NS 16 (29.1) 11 (31.4) NS
Urge incontinence 13 (21) 12 (14.8) NS 9 (16.4) 5 (14.3) NS
Stress incontinence 26 (42) 31 (38.3) NS 16 (29.1) 9 (25.7) NS
Values are given as numbers (%); NS: not significant.
R. de Tayrac et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 130 (2007) 258–261 261
including urge and stress incontinence has revealed none [6] Hwang JL, Seow KM, Tsai YL, Huang LW, Hsieh BC, Lee C.
difference for women with or without a history of vaginal Comparative study of vaginal, laparoscopically assisted vaginal and
abdominal hysterectomies for uterine myoma larger than 6 cm in
hysterectomy. Since follow-up is considered to be an diameter or uterus weighing at least 450 g: a prospective randomised
important modifier of the effect of hysterectomy on urinary study. Acta Obstet Gynecol Scand 2002;81(12):1132–8.
incontinence, a separate analysis was performed for follow- [7] Benassi L, Rossi T, Kaihura CT, et al. Abdominal or vaginal hyster-
up less and more than 5 years from the operation. Again, this ectomy for enlarged uteri: a randomised clinical trial. Am J Obstet
Gynecol 2002;187(6):1561–5.
analysis has revealed none difference.
[8] Miskry T, Magos A. Randomized, prospective, double-blind compar-
The fact that questionnaires have been send to women after ison of abdominal and vaginal hysterectomy in women without
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