Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study.
BACKGROUND
Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation.


OBJECTIVE
The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders.


METHODS
This was a prospective and longitudinal study.


METHODS
The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women's Health Research and Education Hospital between September 2008 and March 2011.


METHODS
The study was performed on patients who underwent hysterectomy for benign pathologies.


METHODS
A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years.


RESULTS
Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4.


CONCLUSIONS
Although the study had several limitations, no comparison with a control population was the most important one.


CONCLUSIONS
Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.
1Department of Surgery, Ankara University, Ankara, Turkey 2Department of Biostatistics, Ankara University, Ankara, Turkey 3Department of Obstetrics and Gynecology, Dr Zekai Tahir Burak Women Health Research and Education Hospital, Ankara, Turkey.
Akin Firat
AF
Kocaay
Derya
D
Oztuna
Filiz Akin
FA
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Atilla Halil
AH
Elhan
Mehmet Ayhan
MA
Kuzu
D000328:Adult; D000368:Aged; D003248:Constipation / Q000209:etiology; D005187:Fallopian Tubes / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D007415:Intestinal Obstruction / Q000209:etiology; D008137:Longitudinal Studies; D008875:Middle Aged; D010052:Ovariectomy; D059952:Pelvic Floor Disorders / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000209:etiology