A study has compared the rates of urinary incontinence and other complications of subtotal abdominal hysterectomy ( SAH ) with total abdominal hysterectomy ( TAH ) at 5 years after surgery.
Danish multi-centre, randomised, clinical trial was performed on women referred with benign uterine diseases scheduled for abdominal hysterectomy.
Women were randomised to either SAH ( n=161 ) or TAH ( n=158 ). Follow-up data were collected from participants using postal questionnaires sent out 5 years after surgery.
Intention-to-treat and per-protocol analyses were conducted.
The primary outcome was urinary incontinence. Secondary outcomes included constipation, prolapse of the vaginal vault or cervical stump, satisfaction with sexual life, pelvic pain, postoperative complications and vaginal bleeding.
The response rate was 234/319 ( 73.4% ). A significantly higher proportion of respondents had urinary incontinence 5 years after SAH 34/113 ( 30.1% ) than TAH 21/119 ( 17.6% ) ( RR 1.71; P = 0.026 ).
This difference reduced after multiple imputation to account for missing data ( RR 1.37; P = 0.052 ).
Eleven of the 101 women ( 11% ) in the subtotal abdominal hysterectomy group still experienced vaginal bleeding.
No other differences were found between the two types of abdominal hysterectomy.
In conclusion, a smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy 5 years postoperatively.
Around one in ten women continued to experience vaginal bleeding 5 years after subtotal abdominal hysterectomy. ( Xagena )
Andersen L et al, BJOG 2014; Epub ahead of print