A comparison of bladder and ovarian function two years following hysterectomy or endometrial ablation.
OBJECTIVE
To test the hypothesis that at two years bladder and ovarian function function are no different following either simple hysterectomy or endometrial ablation (transcervical resection/laser ablation).


METHODS
Randomised controlled trial comparing hysterectomy with endometrial ablation. Two years after trial entry bladder and ovarian function were evaluated subjectively by means of questionnaires and objectively by means of cystometry and estimation of serum follicle stimulating hormone respectively.


METHODS
Aberdeen Royal Infirmary.


METHODS
Tow hundred and four women with dysfunctional uterine bleeding who, when recruited to the initial study two years previously, were aged less than 50 years, weighed less than 100 kg, and who would otherwise have undergone hysterectomy.


RESULTS
Of the 204 women originally recruited, 101 re-attended the clinic and underwent cystometry and follicle stimulating hormone estimation. These, together with a further 59 women, completed postal questionnaires (79% of original cohort). Rates of stress incontinence (44% vs 44%, 95% CI of difference -16% to +15%), urge incontinence (21% vs 19% 95% CI of difference -11% to +14%), and hot flushes (30% vs 44%, 95% CI of difference -25% to +7%) were similar in the hysterectomy and endometrial ablation groups, respectively. Cystometry revealed 14 (31%) cases of bladder dysfunction after hysterectomy and 17 (35%) after hysteroscopic surgery (95% CI of difference -23% to +15%). Serum follicle stimulating hormone levels > 40 IU/L [corrected] were found in three (6%) women following hysterectomy and five (10%) of women after endometrial ablation.


CONCLUSIONS
This study suggests that in comparison with endometrial ablation, simple hysterectomy for dysfunctional uterine bleeding does not compromise bladder or ovarian function, at least at two years after the operation. Due to lack of power the estimates of any differences are imprecise, and clinically significant effects cannot be ruled out.
Bhattacharya
S
S
Aberdeen Royal Infirmary, UK.
Mollison
J
J
Pinion
S
S
Parkin
D E
DE
Abramovich
D R
DR
Terry
P
P
Kitchener
H C
HC
D000328:Adult; D002979:Climacteric; D015331:Cohort Studies; D004717:Endometrium / Q000601:surgery*; D015914:Estrogen Replacement Therapy; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D053685:Laser Therapy / Q000009:adverse effects; D010049:Ovarian Diseases / Q000209:etiology*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000209:etiology*; D014549:Urinary Incontinence / Q000209:etiology; D014592:Uterine Hemorrhage / Q000601:surgery*
D005640:Follicle Stimulating Hormone