title: Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up.
abstract: OBJECTIVE
  To compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases.
  
  
  METHODS
  Long-term follow-up of a randomized clinical trial of subtotal vs. total abdominal hysterectomy with objective outcomes. All randomized women still alive and living in Denmark (n=304) were invited to answer a questionnaire and come for clinical examination consisting of 20-min pad weighing test, urinary flow, measurement of residual urine, POP-Q measurement for pelvic organ prolapse, 3 day voiding diary and also filled out the pelvic floor distress inventory (PFDI-20) questionnaire.
  
  
  RESULTS
  We included 100/304 (32.9%) women (subtotal hysterectomy: 53, total hysterectomy: 47) in the clinical examinations. The study questionnaire was answered by 197 (64.8%) (subtotal: 97, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group, 31 (59.6%) women had objective stage 2 pelvic organ prolapse compared with 33 (70.2%) in the total hysterectomy group (P=0.27); however, only 6/31 and 9/33 had symptoms (P=0.45). There were more anterior pelvic organ prolapses in the total hysterectomy group (N=10) than in the subtotal hysterectomy group (N=4) (P=0.048). We found a higher mean maximum flow rate (Qmax) in the subtotal hysterectomy group (34.78ml/s) than in the total hysterectomy group (27.08ml/s) (P=0.042) as well as a higher mean functional capacity in the subtotal hysterectomy group (526ml) than in the total hysterectomy group (443ml) (P=0.0147) according to the voiding diary.
  
  
  CONCLUSIONS
  Subtotal and total abdominal hysterectomy are comparable regarding long-term objective pelvic organ prolapse and urinary incontinence. The subtotal hysterectomy group had a higher Qmax and voided volume.
authors.affiliation: Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark; Department of Women and Children's Health 7821, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; University of Southern Denmark, Denmark. Electronic address: lealairdandersen@gmail.com.
authors.forename: Lea L
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: Department of Obstetrics and Gynecology, Roskilde Hospital, Roskilde, Denmark.
authors.forename: Lars M
authors.initials: LM
authors.lastname: Alling Møller
authors.affiliation: Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
authors.forename: Helga M
authors.initials: HM
authors.lastname: Gimbel
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000209:etiology*; D010808:Physical Examination; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology*
keywords: Hysterectomy; Long-term; Pelvic organ prolapse; Randomized clinical trial; Voiding function