Andersen Lea Laird, Møller Lars Mikael Alling, Gimbel Helga
Department of Obstetrics and Gynecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
Department of Women and Children's Health 7821, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Int Urogynecol J. 2015 Dec;26(12):1767-72. doi: 10.1007/s00192-015-2778-6. Epub 2015 Jul 28.
Lower urinary tract symptoms (LUTS) are common after hysterectomy and increase after menopause. We aimed to compare subtotal with total abdominal hysterectomy regarding LUTS, including urinary incontinence (UI) subtypes, 14 years after hysterectomy. Main results from this randomized clinical trial have been published previously; the analyses covered in this paper are exploratory.
We performed a long-term questionnaire follow-up of women in a randomized clinical trial (n = 319), from 1996 to 2000 comparing subtotal with total abdominal hysterectomy. Of the randomized women, ten had died and five had left Denmark; 304 women were contacted. For univariate analyses, a χ(2)-test was used, and for multivariate analyses, we used logistic regression.
The questionnaire was answered by 197 (64.7 %) women (subtotal 97; total 100). More women had subjective stress UI (SUI) in the subtotal group (n = 60; 62.5 %) compared with the total group (n = 45; 45 %), with a relative risk (RR) of 1.39 [95 % confidence interval (CI) 1.06-1.81; P = 0.014]. No difference was seen between subtotal and total abdominal hysterectomy in other LUTS. Factors associated with UI were UI prior to hysterectomy, local estrogen treatment, and body mass index (BMI) > 25 kg/m(2). High BMI was primarily associated with mixed UI (MUI) and urgency symptoms. Predictors of bothersome LUTS were UI and incomplete bladder emptying.
The difference in the frequency of subjectively assessed UI between subtotal and total abdominal hysterectomy (published previously) is caused by a difference in subjectively assessed SUI; UI prior to hysterectomy and high BMI are related to UI 14 years after hysterectomy.
The trial is registered on clinicaltrials.gov under Nykoebing Falster County Hospital Record sj-268: Total versus subtotal hysterectomy: http://clinicaltrials.gov/ct2/show/NCT01880710?term=hysterectomy&rank=27.
子宫切除术后下尿路症状（LUTS）很常见，且绝经后会加重。我们旨在比较子宫次全切除术与全腹子宫切除术术后14年的LUTS情况，包括尿失禁（UI）亚型。这项随机临床试验的主要结果已在之前发表；本文所涵盖的分析为探索性分析。
我们对1996年至2000年一项比较子宫次全切除术与全腹子宫切除术的随机临床试验中的女性进行了长期问卷调查随访（n = 319）。在随机分组的女性中，10人死亡，5人离开丹麦；联系到了304名女性。单因素分析采用χ²检验，多因素分析采用逻辑回归。
197名（64.7%）女性回复了问卷（次全切除组97名；全切除组100名）。与全切除组（n = 45；45%）相比，次全切除组主观压力性尿失禁（SUI）的女性更多（n = 60；62.5%），相对风险（RR）为1.39 [95%置信区间（CI）1.06 - 1.81；P = 0.014]。子宫次全切除术与全腹子宫切除术在其他LUTS方面未见差异。与尿失禁相关的因素有子宫切除术前的尿失禁、局部雌激素治疗以及体重指数（BMI）> 25 kg/m²。高BMI主要与混合性尿失禁（MUI）和尿急症状相关。令人困扰的LUTS的预测因素是尿失禁和膀胱排空不全。
子宫次全切除术与全腹子宫切除术之间主观评估的尿失禁频率差异（之前已发表）是由主观评估的SUI差异所致；子宫切除术前的尿失禁和高BMI与子宫切除术后14年的尿失禁有关。
该试验在clinicaltrials.gov上注册，编号为Nykoebing Falster县医院记录sj - 268：全子宫切除术与次全子宫切除术对比：http://clinicaltrials.gov/ct2/show/NCT01880710?term=hysterectomy&rank=27 。
