Urodynamic Outcomes After Hysterectomy for Benign Conditions: A Systematic Review and Meta-analysis

Background. Hysterectomy, the most common gynecological surgery performed in the United Kingdom, has been highlighted as a possible etiological factor in urinary dysfunction in women who have undergone nonradical hysterectomy. Multiple studies in recent years have examined this question with both clinical and urodynamics metrics. Aims. The aim of this systematic review was to analyze urodynamic outcomes before and after total hysterectomy for benign conditions, and report if urinary function was changed after hysterectomy. Methods. English articles on MEDLINE and CINAHL from 1950 to February 2009 and on Web of Knowledge all years were searched. The search strategy used combinations of search terms related to urinary function and hysterectomy. The keywords used were "urodynamics," " stress incontinence," "urge incontinence," "bladder instability," "overactive bladder," "detrusor overactivity," and "hysterectomy." Observational studies and randomized controlled trials investigating urodynamic outcomes before and after hysterectomy were included. The data were analyzed in Review Manager 5 software. Results. Overall, symptoms of urinary incontinence were significantly reduced after hysterectomy (relative risk [RR] = 1.37, 95% confidence interval [CI] [1.01, 1.84]). The urodynamic diagnosis of detrusor overactivity was significantly reduced after hysterectomy (RR = 1.58, 95% CI [1.16, 2.16]), but there was no significant reduction in the prevalence of urodynamic stress incontinence after hysterectomy (RR = 0.89, 95% CI [0.58, 1.38]). There was no significant change to urine flow rate after hysterectomy (RR = -0.36, 95% CI [-1.40, 0.68]). Conclusions. Hysterectomy for benign gynecological conditions does not adversely impact urodynamic outcomes nor does it increase the risk of adverse urinary symptoms and may even improve some urinary function. Target Audience: Obstetricians & Gynecologists and Family Physicians. Learning Objectives: After the completing the CME activity, physicians should be better able to categorize changes in urinary function following hysterectomy, assess changes in urinary symptoms following hysterectomy.