title: Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy.
abstract: OBJECTIVE
  To compare the rates of urinary incontinence (UI) and other complications of subtotal abdominal hysterectomy (SAH) with total abdominal hysterectomy (TAH) at 5 years after surgery.
  
  
  METHODS
  Randomised clinical trial with central, computer-generated randomisation.
  
  
  METHODS
  Danish multi-centre trial performed in 11 departments of gynaecology.
  
  
  METHODS
  Women referred with benign uterine diseases scheduled for abdominal hysterectomy.
  
  
  METHODS
  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. Complications of hysterectomy were further examined by scrutinising registered discharge summaries following hospitalisation. Intention-to-treat and per-protocol analyses were conducted. Potential bias caused by missing data was handled using multiple imputation.
  
  
  METHODS
  The primary outcome was UI. Secondary outcomes included constipation, prolapse of the vaginal vault or cervical stump, satisfaction with sexual life, pelvic pain, postoperative complications and vaginal bleeding.
  
  
  RESULTS
  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, 95% confidence interval 1.06-2.75, P = 0.026). This difference reduced after multiple imputation to account for missing data (RR 1.37, 95% confidence interval 0.99-1.89, P = 0.052). Eleven of the 101 women (11%) in the SAH group still experienced vaginal bleeding. No other differences were found between the two types of abdominal hysterectomy.
  
  
  CONCLUSIONS
  A smaller proportion of women suffered from UI after TAH than after SAH 5 years postoperatively. Around one in ten women continued to experience vaginal bleeding 5 years after SAH.
authors.affiliation: Department of Obstetrics and Gynaecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: L L
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: V
authors.initials: V
authors.lastname: Zobbe
authors.affiliation: Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Ottesen
authors.affiliation: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Gluud
authors.affiliation: Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Tabor
authors.affiliation: Department of Obstetrics and Gynaecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Gimbel
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D057194:Intention to Treat Analysis; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology*; D014591:Uterine Diseases / Q000601:surgery*
keywords: Complications; hysterectomy; long-term follow-up; pelvic organ prolapse; randomised; urinary incontinence