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Improvement in urinary incontinence seen after hysterectomy for noncancerous conditions

Urinary incontinence (UI) seems to improve at least for the first 2 years after hysterectomy for most women who have moderate or severe incontinence prior to surgery. However, if they have mild or no incontinence before hysterectomy, there is a 10 percent risk of worse or new-onset UI after the surgery, according to a study supported by the Agency for Healthcare Research and Quality (HS06865).

Researchers at the University of Maryland used the Urinary Symptom Scale for Women (USSW), which they developed, to assess incontinence during interviews with 1,299 women before hysterectomy and again 3, 6, 12, 18, and 24 months after surgery. The USSW measures five types of UI: stress incontinence (urine drip during sneezing or coughing), urge incontinence (need to urinate urgently with little or no warning), urinary frequency (three or more times per hour), overflow incontinence (dripped or leaked urine), and incomplete emptying (need to urinate again shortly after urination). Scores on each of these USSW measures and total score (based on number and severity of symptoms) decreased after hysterectomy and remained about the same for 2 years after surgery for most women with severe or moderate UI.

Women with severe UI before hysterectomy were more likely to experience improved incontinence (89 percent) 1 year after surgery than those with moderate (62 percent) and mild/no incontinence (8 percent). On the other hand, women with mild/no incontinence were more likely to have worse incontinence (17 percent) 1 year after hysterectomy than those with moderate (10 percent) and severe (3 percent) incontinence before hysterectomy. Similar results were noted 2 years after surgery.

Details are in "Urinary incontinence and hysterectomy in a large prospective cohort study in American women," by Kristen H. Kjerulff, Ph.D., Patricia W. Langenberg, Ph.D., Lavonne Greenaway, M.D., and others, in the May 2002 Journal of Urology 167, pp. 2088-2092.

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