Urinary incontinence following subtotal and total hysterectomy: a systematic review

Longo, Priscila Scalabrin; Borbily, Laura Virilo; Glina, Felipe Placco Araujo

doi:10.31744/einstein_journal/2019RW4320

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Sumário

Review • EINSEinstein (São Paulo) 17 (2) • 2019 • https://doi.org/10.31744/einstein_journal/2019RW4320 copy

Urinary incontinence following subtotal and total hysterectomy: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the best surgical approach for the female urinary incontinence.

Methods:

Systematic review conducted in MEDLINE^® Cochrane, EMBASE and LILACS database up to September 1^st, 2017. Articles were selected according to study type, type of intervention and outcomes. Articles were selected by more than one researcher based on title, abstract and full text. The SIGN checklist was used for bias assessment.

Results:

A total of 165 articles were retrieved from MEDLINE^® . Twenty-five studies were elected for full text reading, and 11 of them were selected for the final text analysis. The heterogeneity between questionnaires used in different studies precluded a meta-analysis of results.

Conclusion:

This study yielded evidences supporting the hypothesis that total and subtotal hysterectomy have different impacts on urinary function of patients with benign uterine diseases. Articles revealed higher frequency of urinary incontinence following subtotal compared to total hysterectomy.

Keywords:
Hysterectomy; Uterine diseases; Urinary incontinence

Article	Reasons for exclusion
Kocaay et al.⁽¹1. Kocaay AF, Oztuna D, Su FA, Elhan AH, Kuzu MA. Effects of hysterectomy on pelvic floor disorders: a longitudinal study. Dis Colon Rectum. 2017;60(3):303-10.⁾	Does not contain separate analysis of the intervention or comparison of results
Ala-Nissilä et al.⁽²2. Ala-Nissilä S, Haarala M, Järvenpää T, Mäkinen J. Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2017;28(2):299-306.⁾	Not randomized
Selcuk et al.⁽⁸8. Selcuk S, Cam C, Asoglu MR, Kucukbas M, Arinkan A, Cikman MS, et al. Effect of simple and radical hysterectomy on quality of life - analysis of all aspects of pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol. 2016;198:84-8.⁾	Includes patients with malignant diseases
Gilbaz et al.⁽⁹9. Gilbaz E, Gungor Ugurlucan F, Aslay I, Yalcin O. The effects of simple and radical hysterectomy and radiotherapy on lower urinary tract symptoms and urodynamics. Eur J Gynaecol Oncol. 2013;34(3):248-53.⁾	Includes patients with malignant diseases
Rabinerson et al.⁽¹⁰10. Rabinerson D, Melamed N, Glezerman M. [Gynecologic pelvic surgery for benign conditions and its postoperative e effect on womens' sexuality]. Harefuah.2008;147(3):247-51, 277, 276. Review. Hebrew.⁾	Full text in Hebrew
Al-Mehaisen et al.⁽¹³13. Al-Mehaisen LM, Al-Kuran O, Lataifeh I, Ramsay I. Effect of abdominal hysterectomy on developing urinary and faecal incontinence later in life. J Obstet Gynaecol. 2009;29(8):742-8.⁾	Does not contain separate analysis of the intervention or comparison of results
Morelli et al.⁽¹⁴14. Morelli M, Noia R, Chiodo D, Mocciaro R, Costantino A, Caruso MT, et al. [Laparoscopic supracervical hysterectomy versus laparoscopic total hysterectomy: a prospective randomized study]. Minerva Ginecol. 2007; 59(1):1-10. Italian.⁾	Full text in Italian
Engh et al.⁽¹⁵15. Engh MA, Otterlind L, Stjerndahl JH, Löfgren M. Hysterectomy and incontinence: a study from the Swedish national register for gynecological surgery. Acta Obstet Gynecol Scand. 2006;85(5):614-8.⁾	Not a clinical trial
Walsh et al.⁽¹⁶16. Walsh K, Stone AR. How is the lower urinary tract affected by gynaecological surgery? BJU Int. 2004;94(3):272-5.⁾	Not a clinical trial
El-Toukhy et al.⁽¹⁷17. El-Toukhy TA, Hefni M, Davies A, Mahadevan S. The effect of different types of hysterectomy on urinary and sexual functions: a prospective study. J Obstet Gynaecol. 2004;24(4):420-5.⁾	Not a clinical trial
Neumann et al.⁽¹⁸18. Neumann G, Olesen PG, Hansen V, Lauszus FF, Ljungstrøm B, Rasmussen KL. The short-term prevalence of de novo urinary symptoms after different modes of hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15(1):14-9.⁾	Does not contain separate analysis of the intervention or comparison of results
Roovers et al.⁽¹⁹19. Roovers JP, van der Bom JG, Huub van der Vaart C, Fousert DM, Heintz AP. Does mode of hysterectomy influence micturition and defecation? Acta Obstet Gynecol Scand. 2001;80(10):945-51.⁾	Not a clinical trial
Gimbel et al.⁽²⁰20. Gimbel H, Zobbe V, Andersen BM, Gluud C, Ottesen BS, Tabor A; Danish Hysterectomy Group. Total versus subtotal hysterectomy: an observational study with one-year follow-up. Aust N Z J Obstet Gynaecol. 2005;45(1):64-7.⁾	Not randomized
Gimbel et al.⁽²¹21. Gimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG. 2003;110(12):1088-98.⁾	Crossover of 22%

Articles	Study type	Patients	TH	STH	Questionnaire	Follow up (years)	Number of participants (intervention/ comparison group)
Andersen et al.⁽³3. Andersen LL, Alling Møller LM, Gimbel HM. Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2015;193:40-5.⁾	RCT	ND/BUP	A	A	PFDI-20	14	158/161
Andersen et al.⁽⁴4. Andersen LL, Møller LM, Gimbel H; Danish Hysterectomy Trial Group. Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy: exploratory analyses from a randomized clinical trial with a 14-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct. 2015;26(12):1767-72.⁾	RCT	BUP, >18 years	A	A	PFDI-20/SF-36	14	100/97
Andersen et al.⁽⁵5. Andersen LL, Zobbe V, Ottesen B, Gluud C, Tabor A, Gimbel H; Danish Hysterectomy Trial Group. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy. BJOG. 2015; 122(6):851-7.⁾	RCT	BUP, >18 years	A	A	PFDI-20/SF-36	5	158/161
Greer et al.⁽⁶6. Greer WJ, Richter HE, Wheeler TL, Varner RE, Szychowski JM, Kuppermann M, et al. Long-Term Outcomes of the Total or Supracervical Hysterectomy (TOSH) Trial. Female Pelvic Med Reconstr Surg. 2010;16(1):49-57.⁾	RCT	BUP, PREM 30-50 years	A	A	HRQOL/SF-36	9	27/27
Andersen et al.⁽⁷7. Andersen LL, Ottesen B, Alling Møller LM, Gluud C, Tabor A, Zobbe V, Hoffmann E, Gimbel HM; Danish Hysterectomy Trial Group. Subtotal versus total abdominal hysterectomy: randomized clinical trial with 14-year questionnaire follow-up. Am J Obstet Gynecol. 2015;212(6):758. e1-54.⁾	RCT	ND/BUP	A	A	PFDI-20/SF-36	14	100/97
Gimbel et al.⁽²⁰20. Gimbel H, Zobbe V, Andersen BM, Gluud C, Ottesen BS, Tabor A; Danish Hysterectomy Group. Total versus subtotal hysterectomy: an observational study with one-year follow-up. Aust N Z J Obstet Gynaecol. 2005;45(1):64-7.⁾	RCT	BUP	A	A	IIQ	0 and 1	158/161
Learman et al.⁽²²22. Learman LA, Summitt RL Jr, Varner RE, McNeeley SG, Goodman-Gruen D, Richter HE, Lin F, Showstack J, Ireland CC, Vittinghoff E, Hulley SB, Washington AE; Total or Supracervical Hysterectomy (TOSH) Research Group. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol. 2003;102(3):453-62.⁾	RCT	BUP	A	A	IIQ	2	68/67
Thakar et al.⁽²³23. Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318-25.⁾	RCT	BP	A	A	IIQ	1	133/146

SIGN checklist	Andersen et al.⁽³3. Andersen LL, Alling Møller LM, Gimbel HM. Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2015;193:40-5.^,⁴4. Andersen LL, Møller LM, Gimbel H; Danish Hysterectomy Trial Group. Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy: exploratory analyses from a randomized clinical trial with a 14-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct. 2015;26(12):1767-72.^,⁷7. Andersen LL, Ottesen B, Alling Møller LM, Gluud C, Tabor A, Zobbe V, Hoffmann E, Gimbel HM; Danish Hysterectomy Trial Group. Subtotal versus total abdominal hysterectomy: randomized clinical trial with 14-year questionnaire follow-up. Am J Obstet Gynecol. 2015;212(6):758. e1-54.⁾	Andersen et a.⁽⁵5. Andersen LL, Zobbe V, Ottesen B, Gluud C, Tabor A, Gimbel H; Danish Hysterectomy Trial Group. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy. BJOG. 2015; 122(6):851-7.⁾	Greer et al.⁽⁶6. Greer WJ, Richter HE, Wheeler TL, Varner RE, Szychowski JM, Kuppermann M, et al. Long-Term Outcomes of the Total or Supracervical Hysterectomy (TOSH) Trial. Female Pelvic Med Reconstr Surg. 2010;16(1):49-57.⁾	Gimbel et al.⁽²⁰20. Gimbel H, Zobbe V, Andersen BM, Gluud C, Ottesen BS, Tabor A; Danish Hysterectomy Group. Total versus subtotal hysterectomy: an observational study with one-year follow-up. Aust N Z J Obstet Gynaecol. 2005;45(1):64-7.⁾	Gimbel et al.⁽²¹21. Gimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG. 2003;110(12):1088-98.⁾	Learman et al.⁽²²22. Learman LA, Summitt RL Jr, Varner RE, McNeeley SG, Goodman-Gruen D, Richter HE, Lin F, Showstack J, Ireland CC, Vittinghoff E, Hulley SB, Washington AE; Total or Supracervical Hysterectomy (TOSH) Research Group. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol. 2003;102(3):453-62.⁾	Thakar et al.⁽²³23. Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318-25.⁾
1.1. The study addresses an appropriate and clearly focused question	Yes	Yes	Yes	Yes	Yes	Yes	Yes
1.2. The assignment of subjects to treatment groups is randomized	Yes	Yes	Yes	No	Yes	Yes	Yes
1.3. Adequate concealment method is used	Cannot say	Yes	Yes	Cannot say	Yes	Yes	Yes
1.4. Subjects and investigators are kept “blinded” to treatment allocation	No	Cannot say	Yes	Cannot say	No	Yes	Yes
1.5. Treatment and control groups are similar at the start of the trial	Yes	Yes	Yes	Yes	Yes	Yes	Yes
1.6. The only difference between groups is the treatment being investigated	Yes	Yes	No	Yes	Yes	Yes	Yes
1.7. Relevant outcomes are measured in a standardized, valid and reliable way	Yes	Yes	Yes	Yes	Yes	Yes	Yes
1.8. What percentage of individuals or clusters recruited into each treatment arm of the study dropped out before study completion?	15%	Not described	Not described	15%	22.9%	Not described	Not described
1.9. All studies are analyzed in the groups to which they were randomly allocated (often referred to as intention to treat analysis)	Yes	Yes	Yes	Cannot say	Yes	Yes	Cannot say
1.10. For studies carried out in more than one site, results are comparable for all sites	Yes	Yes	Cannot say	Yes	Yes	Cannot say	Cannot say
2.1. How well was the study performed to minimize bias?	Acceptable	Acceptable	Acceptable	Acceptable	Acceptable	Acceptable	Acceptable

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[1] Corresponding author: Priscila Scalabrin Longo Rua Professor Alexandre Correia, 371, room 81 - Morumbi Zip code: 05657-230 - São Paulo, SP, Brazil Phone: (55 11) 3758-7430 E-mail: priscilalongo@ymail.com