Clinical Characteristics of Women Choosing Concurrent Anti-incontinence Surgery at Time of Hysterectomy for Endometrial Cancer

Wohlrab K1, Sung V W1, Robison K1, Howe C2, Lowder J3, Occhino J4, Dunivan G C5, Rahn D I6, Tunitsky E7, Chen G8, Clark M9, Richter H E10

Research Type


Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 282
Female Incontinence
Scientific Podium Short Oral Session 16
Thursday 30th August 2018
09:50 - 09:57
Hall C
Stress Urinary Incontinence Clinical Trial Quality of Life (QoL) Prospective Study Surgery
1. Women & Infants Hospital / Brown University, 2. Brown University, 3. Washington University in St Louis, 4. Mayo Clinic, 5. University of New Mexico, 6. UT Southwestern, 7. Hartford Hospital, 8. Johns Hopkins University, 9. University of Massachusetts, 10. University of Alabama at Birmingham

Kyle Wohlrab



Hypothesis / aims of study
Stress urinary incontinence (SUI) and endometrial cancer share common risk factors. The surgical treatment of both SUI and endometrial cancer is associated with high success rates and can be performed concomitantly. The aim of this novel study is to describe the clinical and demographic characteristics of women who choose to undergo concurrent anti-incontinence surgery at the time of their hysterectomy for endometrial cancer.
Study design, materials and methods
This is a secondary analysis of data from the Cancer of the Uterus and Treatment of Incontinence (CUTI) study. CUTI is a large, multi-site prospective cohort study of women with early stage endometrial cancer or hyperplasia undergoing hysterectomy. At the time of their oncology appointment, women were screened for SUI with the question “Do you leak urine with cough, sneeze, jump or laugh?” Women who answered ‘yes’ were offered enrollment and referral to urogynecology. Women choosing referral to urogynecology were evaluated per standard of care, and depending on clinical diagnosis, were offered treatment for SUI or other pelvic floor disorders at the discretion of the consulting urogynecologist. Validated measures collected from the patients included the Sandvik Severity Index (SSI), Urogenital Distress Inventory (UDI), Incontinence Impact Questionnaire (IIQ) and the Female Sexual Function Index (FSFI). Clinical characteristics and patient-reported outcomes were compared for those choosing concurrent surgical treatment to those who did not.
1,322 women were screened for SUI across eight sites. 702 (53.1%) women screened positive. 556 (79.2%) women enrolled in the CUTI study, 261 (46.9%) opted for urogynecology referral, and 237 completed an evaluation. 102 / 237 (43%) women underwent concurrent surgery. There were no differences in age, race, BMI, insurance status, education, or cancer histology between women choosing concurrent surgery and those who did not. A higher proportion of women choosing concurrent surgery had documented SUI on exam (80.7% vs 19.3%, p<0.0001). Women who chose concurrent surgery had higher UDI scores than those who did not (95.9 vs 81.4, p<0.043). UDI-stress subscale scores were higher for women who chose concurrent surgery (47.5 vs 35.3, p=0.0002), but irritative scores did not differ between groups (32.6 vs 30.9, p=0.55). IIQ scores were not significantly different between the concurrent surgery vs non-concurrent surgery groups (28.1 vs 22.2, p=0.087), respectively. The two most common reasons for not having concomitant surgery were ‘SUI not severe enough’ and ‘Urge-predominant symptoms.’ Only 10 women reported ‘Fear of mesh’ and ‘risk of complications’ as reasons for not choosing concurrent surgery. Ten women underwent prolapse surgery in addition to an anti-incontinence procedure; repair of the posterior compartment was the most common prolapse procedure performed (n=8).
Interpretation of results
A majority of women with endometrial cancer also report SUI, with nearly 50% choosing evaluation of their urinary leakage prior to their oncology surgery. Clinical findings of SUI and reporting bothersome urinary leakage are associated with choosing concurrent anti-incontinence surgery at the time of hysterectomy for endometrial cancer.
Concluding message
Longer-term comparative outcomes on symptom specific and general quality of life will be important to assess.
<span class="text-strong">Funding</span> PCORI - Patient Centered Outcomes Research Institute <span class="text-strong">Clinical Trial</span> Yes <span class="text-strong">Registration Number</span> NCT02667431 <span class="text-strong">RCT</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> Women & Infants IRB <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes