title: Patient-reported lower urinary tract symptoms after hysterectomy or hysteroscopy: a study from the Swedish Quality Register for Gynecological Surgery.
abstract: OBJECTIVE
  Hysterectomy is sometimes considered the cause of lower urinary tract symptoms (LUTS). We hypothesized that hysterectomy for abnormal uterine bleeding and/or symptoms of fibroids is more likely to cause LUTS than a hysteroscopic procedure for the same indications.
  
  
  METHODS
  Two groups of women were compared: one group comprised 3,618 women who had had a hysterectomy due to abnormal uterine bleeding or symptoms of fibroids and the other group comprised 238 women who had had hysteroscopic treatment for the same indications. The main outcome measures were occurrence of LUTS before and 1 year after the surgical intervention. The frequencies of LUTS before and after surgery were compared between the groups. Binary logistic regression was used to model the odds of having postoperative urinary leakage and urgency while controlling for uterine size, surgical procedure and preoperative LUTS.
  
  
  RESULTS
  There were no statistically significant differences between women after hysterectomy and after hysteroscopy in the frequencies of LUTS before or after surgery, when uterine size was comparable. However, there was a difference in the rates of de novo urinary incontinence between women with hysterectomy and women with hysteroscopy (7.6%, 95% CI 6.3-9.0, and 3.2%, 95% CI 1.6-6.5, respectively). Of the women with a large uterus, 58.6% (95% CI 51.5-65.5) reported relief of urinary incontinence and 85.5% (95% CI 82.3-88.4) reported relief of urinary urgency postoperatively.
  
  
  CONCLUSIONS
  Our results suggest that it is important to individualize preoperative information in women prior to hysterectomy since the outcome concerning LUTS depends on preoperative symptoms and uterine size.
authors.affiliation: Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. mathias.palsson@vgregion.se.|Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden. mathias.palsson@vgregion.se.
authors.forename: Mathias
authors.identifier: http://orcid.org/0000-0001-9382-0048
authors.initials: M
authors.lastname: Pålsson
authors.affiliation: Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Jan-Henrik
authors.initials: JH
authors.lastname: Stjerndahl
authors.affiliation: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Granåsen
authors.affiliation: Department of Clinical Science, Obstetrics and Gynaecology, Umeå University Hospital, Umeå, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Löfgren
authors.affiliation: Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Sundfeldt
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015907:Hysteroscopy / Q000009:adverse effects*; D007889:Leiomyoma / Q000601:surgery*; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000209:etiology; D008796:Metrorrhagia / Q000601:surgery*; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012042:Registries; D013548:Sweden
keywords: Hysterectomy; Hysteroscopy; Quality register; Urinary incontinence; Urinary urgency