Unlike total hysterectomy (TH), supracervical hysterectomy (SCH), also known as subtotal hysterectomy, removes only the body of the uterus, preserving the cervix. In theory, SCH does not damage nerves innervating the bladder and pelvic floor, nor does it disrupt the superior pelvic supports. For these reasons, SCH is thought not to predispose to urinary incontinence. The goal of this meta-analysis was to determine whether the type of hysterectomy performed does, in fact, influence the risk of incontinence. Numerous databases including MEDLINE and the Cochrane Library were searched for abstracts presented at major meetings and bibliographies of retrieved articles. A fixed effect model served to calculate summary relative risk estimates and 95% confidence intervals (CIs).
Three studies, all published in the years 2002–2005, were eligible for analysis. All were randomized trials that followed patients for at least 12 months postoperatively. No statistically significant difference in the risk of developing stress urinary incontinence was found between women undergoing SCH and those having total abdominal hysterectomy. The relative risk (RR) was 1.3, with a 95% CI of 0.94–1.78. The RR for urge urinary incontinence was 1.37 (95% CI, 0.77–2.46). Longer follow-up intervals may be needed to accept the conclusion that the extent of hysterectomy does not influence the risk, because observational studies suggest that urinary incontinence may take years to develop following hysterectomy.
Departments of Obstetrics and Gynecolgy, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Am J Obstet Gynecol 2008;198:264.e1–264.e5