Hypothesis / aims of study
Hysterectomy is one of the most common gynecological procedure. It is believed that hysterectomy itself is a risk factor for urinary incontinence. Female urethra mean length (UL) is 30.1 ± 4.2 mm (minimum 19 mm, maximum 45 mm).Vaginal deliveries and obesity influence urethral length whereas age, height, number of C-sections, average, and maximum birth weight, age at birth of the first and the last child do not correlate with UL .
The aim of this study was to assess the effect of different types of hysterectomy- vaginal (VH), supracervical abdominal (SH) and supracervical laparoscopic (LSH) performed due to benign conditions on postoperative occurrence of urine incontinence and urethral length.
Study design, materials and methods
Study group consisted of 128 women aged between 18-75 years without history of pelvic floor surgery (Table 1). All patients were recruited from women attending the Gynecology Department. All patients had the urethral length measured in pelvic floor ultrasound examination before and 6 months after hysterectomy. Urethral length was measured in a standardized manner (the bladder filled to 200-400ml). The exclusion criteria were inadequate bladder filling (<200 ml or >400 ml), previous history of pelvic floor surgery, and no consent. Additionally patients fulfilled Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7) and the International Consultation on Incontinence Questionnaire (ICIQ) before and 6 months after hysterectomy. For both UDI-6 and IIQ-7, higher score = higher disability – (completely compromised by urinary symptoms = 100). The IIQ-7 measures the impact of urinary incontinence (UI) on activities, roles, and emotional states of women, whereas the UDI-6 measures how troubling the symptoms are.
The ICIQ evaluates the frequency, severity and the impact of urinary incontinence on quality of life. The overall score of ICIQ is from 0 to 21 with greater values indicating increased symptom severity.
Statistical analysis was performed using Statistica v. 12.0 software (StatSoft, Poland). The Wilcoxon signed-rank test compared individual questions preoperatively and postoperatively. Significance was set at p< .05.
Interpretation of results
There was statistically significant difference (downsizing) in urethral length in patients from LSH group before and after the procedure (p=0.03). We observed reduction in UL also in patients after SH but this difference was not statistically significant (p=0.2). There was no difference in UL in patients from VH group (p=0.9).
UDI-6 scores showed that UI symptoms were similar in all study groups before and after the procedure.
IIQ-7 scores showed that the impact of UI on activities, roles, and emotional states of women was the biggest in VH group- patients after VH declared statistically significant improvement (p=0.03) in the psychosocial impact of UI after the procedure. Results of IIQ-7 showed that patients from LSH and SH groups also declared improvement in impact of UI on their life after hysterectomy but this difference was not statistically significant.
ICIQ scored showed statistically significant improvement in the frequency, severity and impact of UI on quality of lifein patients from SH group (p=0.04). In patients from LSH and VH group improvement was observed but the difference was not statistically significant.