Hysterectomy: A Risk Factor for Urinary Incontinence?

Urinary incontinence affects nearly 40% of women. Hysterectomy is also common, and studies of the procedure’s effect on urinary tract function have yielded conflicting results. Now, Swedish investigators have used nationwide registries of surgical procedures and inpatient discharge diagnoses during a 30-year observation period to examine the rates of stress–urinary-incontinence surgery in women who had (165,000) or had not (480,000) undergone hysterectomy.

The rate of surgery for urinary incontinence was 2.4-fold higher in women who underwent hysterectomy than among those who did not (regardless of age or hysterectomy technique). The risk for stress–urinary-incontinence surgery was especially high during the initial 5 years after hysterectomy (hazard ratio, 2.7) but persisted at elevated levels for more than 10 years (HR, 2.1). The combined effect of hysterectomy and multiple vaginal deliveries was pronounced; for example, risk increased 16-fold in women who had four vaginal deliveries and a hysterectomy. When adjusted for other elective surgical interventions not involving the pelvic floor (a measure of tendency to opt for surgical interventions), HRs were largely unchanged.