Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland.
BJOG. 2010 Apr;117(5):602-9. doi: 10.1111/j.1471-0528.2010.02505.x. Epub 2010 Feb 15.
To evaluate the effect of hysterectomy and levonorgestrel-releasing intrauterine system (LNG-IUS) on lower urinary tract symptoms (LUTS) among women treated for menorrhagia.
Randomised controlled trial analysed by actual treatment.
Five university hospitals in Finland.
A cohort of 236 women, aged 35-49 years, referred for menorrhagia between 1994 and 1997.
Women were randomly assigned to treatment by hysterectomy (n = 117) or LNG-IUS (n = 119).
Lower urinary tract symptoms were evaluated by questionnaires at baseline, and after 6, 12 months, 5, and 10 years. Medications and operations for urinary incontinence were confirmed from medical records and national registries.
Overall, 221 (94%) women took part in the 10-year follow-up evaluation. As 55 (46%) women originally randomised to the LNG-IUS group underwent hysterectomy, the results were analysed by actual treatment. Women treated by hysterectomy used more medication for urinary incontinence than LNG-IUS users (12% versus 1%) (OR 9.45, 95% CI 1.24-71.87, P = 0.006). Three hysterectomised women and one LNG-IUS user underwent surgery for stress urinary incontinence (SUI). Women treated by hysterectomy had more urinary tract infections (UTIs) than LNG-IUS users (OR 3.20, 95% CI 1.47-6.96, P = 0.002). Feeling of incomplete emptying (OR 3.00, 95% CI 1.00-9.05, P = 0.04) and SUI (OR 1.83, 95% CI 1.01-3.32, P = 0.04) were more common among women treated by hysterectomy. No differences between the study arms were noted in urge urinary incontinence or by the Urinary Incontinence Severity Score. A multivariate model showed that UTIs were associated with hysterectomy (P = 0.004).
Hysterectomy increases the risks for incomplete emptying, lower UTIs and SUI.
评估子宫切除术和左炔诺孕酮宫内节育系统（LNG-IUS）对接受月经过多治疗的女性下尿路症状（LUTS）的影响。
实际治疗分析的随机对照试验。
芬兰的五所大学医院。
1994 年至 1997 年间因月经过多就诊的 236 名年龄在 35-49 岁的女性。
女性随机分配接受子宫切除术（n=117）或 LNG-IUS（n=119）治疗。
在基线、6、12 个月、5 和 10 年后，通过问卷评估下尿路症状。从病历和国家登记处确认治疗尿失禁的药物和手术情况。
共有 221 名（94%）女性参加了 10 年随访评估。由于最初随机分配到 LNG-IUS 组的 55 名（46%）女性接受了子宫切除术，因此按实际治疗进行了结果分析。接受子宫切除术治疗的女性比 LNG-IUS 使用者更多地使用治疗尿失禁的药物（12%比 1%）（OR 9.45，95%CI 1.24-71.87，P=0.006）。3 名子宫切除术后的女性和 1 名 LNG-IUS 使用者因压力性尿失禁（SUI）接受了手术。接受子宫切除术治疗的女性比 LNG-IUS 使用者更容易发生尿路感染（UTI）（OR 3.20，95%CI 1.47-6.96，P=0.002）。与接受 LNG-IUS 治疗的女性相比，接受子宫切除术治疗的女性更常感到排空不完全（OR 3.00，95%CI 1.00-9.05，P=0.04）和发生 SUI（OR 1.83，95%CI 1.01-3.32，P=0.04）。在急迫性尿失禁或尿失禁严重程度评分方面，两组之间没有差异。多变量模型显示，UTI 与子宫切除术相关（P=0.004）。
子宫切除术增加了排空不完全、下尿路感染和 SUI 的风险。
