title: Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy: exploratory analyses from a randomized clinical trial with a 14-year follow-up.
abstract: OBJECTIVE
  Lower urinary tract symptoms (LUTS) are common after hysterectomy and increase after menopause. We aimed to compare subtotal with total abdominal hysterectomy regarding LUTS, including urinary incontinence (UI) subtypes, 14 years after hysterectomy. Main results from this randomized clinical trial have been published previously; the analyses covered in this paper are exploratory.
  
  
  METHODS
  We performed a long-term questionnaire follow-up of women in a randomized clinical trial (n = 319), from 1996 to 2000 comparing subtotal with total abdominal hysterectomy. Of the randomized women, ten had died and five had left Denmark; 304 women were contacted. For univariate analyses, a χ(2)-test was used, and for multivariate analyses, we used logistic regression.
  
  
  RESULTS
  The questionnaire was answered by 197 (64.7 %) women (subtotal 97; total 100). More women had subjective stress UI (SUI) in the subtotal group (n = 60; 62.5 %) compared with the total group (n = 45; 45 %), with a relative risk (RR) of 1.39 [95 % confidence interval (CI) 1.06-1.81; P = 0.014]. No difference was seen between subtotal and total abdominal hysterectomy in other LUTS. Factors associated with UI were UI prior to hysterectomy, local estrogen treatment, and body mass index (BMI) > 25 kg/m(2). High BMI was primarily associated with mixed UI (MUI) and urgency symptoms. Predictors of bothersome LUTS were UI and incomplete bladder emptying.
  
  
  CONCLUSIONS
  The difference in the frequency of subjectively assessed UI between subtotal and total abdominal hysterectomy (published previously) is caused by a difference in subjectively assessed SUI; UI prior to hysterectomy and high BMI are related to UI 14 years after hysterectomy.
  
  
  BACKGROUND
  The trial is registered on clinicaltrials.gov under Nykoebing Falster County Hospital Record sj-268: Total versus subtotal hysterectomy: http://clinicaltrials.gov/ct2/show/NCT01880710?term=hysterectomy&rank=27.
authors.affiliation: Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark. lealairdandersen@gmail.com.|Department of Women and Children's Health 7821, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. lealairdandersen@gmail.com.|University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark. lealairdandersen@gmail.com.
authors.forename: Lea Laird
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: Department of Obstetrics and Gynecology, Roskilde Hospital, Roskilde, Denmark.
authors.forename: Lars Mikael Alling
authors.initials: LM
authors.lastname: Møller
authors.affiliation: Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Helga
authors.initials: H
authors.lastname: Gimbel
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: BMI; Hysterectomy; LUTS; Long-term outcomes; Subtotal versus total; Urinary incontinence