Urinary incontinence and hysterectomy in a large prospective cohort study in American women

Purpose: We investigated the effects of hysterectomy with and without concomitant urinary incontinence repair on incontinence severity in one of the largest prospective studies of hysterectomy outcomes performed in the United States. Materials and Methods: We administered the Urinary Symptoms Scale for Women to 1,299 women before hysterectomy done for benign conditions, and 6, 12, 18 and 24 months postoperatively to measure the presence, severity and type of urinary incontinence. Results: Before hysterectomy 29.5% of participants had severe urinary incontinence, which decreased to 10% 12 and 24 months after hysterectomy. Most women with severe incontinence before hysterectomy showed improved incontinence 1 year after surgery (89.1%) and were still improved after 2 years (86.5%). The majority of women with moderate incontinence before hysterectomy showed improved incontinence 1 year after surgery (62.4%) and were still improved after 2 years (61.2%). However, some women with mild or no incontinence before hysterectomy had new onset incontinence or the condition had worsened 1 year after surgery (16.7%) and was still worse after 2 years (14.4%). A concomitant urinary incontinence repair procedure significantly increased the probability that a woman with severe incontinence would have improved incontinence 1 year after hysterectomy and significantly decreased the probability that a woman with mild or no incontinence would have worse incontinence after 2 years. Conclusions: The majority of women who undergo hysterectomy for nonmalignant indications experienced improved urinary incontinence during the first 2 years after surgery.