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Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study

Kocaay, Akin Firat M.D.; Oztuna, Derya Ph.D.; Su, Filiz Akin M.D.; Elhan, Atilla Halil Ph.D.; Kuzu, Mehmet Ayhan M.D.

Diseases of the Colon & Rectum: March 2017 - Volume 60 - Issue 3 - p 303–310
doi: 10.1097/DCR.0000000000000786
Original Contributions: Pelvic Floor
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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.

DESIGN: This was a prospective and longitudinal study.

SETTINGS: 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.

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

MAIN OUTCOME MEASURES: 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.

LIMITATIONS: 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

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Los Angeles, CA, April 30 to May 4, 2016.

Correspondence: Mehmet Ayhan Kuzu, M.D., Bestekar Sokak 78/11, Kavaklidere, 06680 Ankara, Turkey. E-mail: ayhankuzu@yahoo.com

© 2017 The American Society of Colon and Rectal Surgeons