NEUROUROLOGY & FEMALE UROLOGY

Postoperative urinary incontinence after total abdominal hysterectomy or supracervical hysterectomy: a metaanalysis
Robert M, Soraisham A, Sauve R
Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
Am J Obstet Gynecol. 2008; 198: 264-5

• Objective: A metaanalysis of randomized trials was conducted to evaluate if the type of hysterectomy, total abdominal hysterectomy or supracervical hysterectomy, has an impact on the development of urinary incontinence.
• Study Design: We searched MEDLINE, EMBASE, CINAHL, Biological Abstract, and the Cochrane Library up to February 2007; abstracts at major meetings and bibliographies of retrieved articles were scanned. A fixed effect model was used to calculate summary relative risk estimates and 95% confidence intervals (CIs).
• Results: Analysis showed no statistical difference in the risk of developing stress or urge urinary incontinence in women who underwent supracervical hysterectomy compared with women who underwent total abdominal hysterectomy (relative risk, 1.3; 95% CI, 0.94-1.78; P = 0.16 and relative risk, 1.37; 95% CI, 0.77-2.46; P = 0.25).
• Conclusion: There is no statistical evidence of a different risk for developing either stress or urge urinary incontinence after a supracervical hysterectomy or a total hysterectomy.
  
  
• Editorial Comment
  The authors noted a current trend towards supracervical hysterectomy as opposed to a total hysterectomy in an effort to diminish surgical impact on underlying patient anatomic structures that involve continence. The authors performed a meta-analysis to gather their data: this spanned relevant articles between 1996 and 2007, ongoing clinical trials, and abstracts performed on the topic. They specifically reviewed comparison of total abdominal hysterectomy and supracervical hysterectomy with regards the development of stress or urinary urge incontinence.
  The authors noted that there was no difference between supracervical hysterectomy and total hysterectomy with regards to voiding dysfunction (stress urinary incontinence, urinary urge incontinence or symptoms of overactive bladder). In fact, they noted that there was a non-significant trend towards increased risk for voiding dysfunction with a supracervical hysterectomy as opposed to total abdominal hysterectomy.
  This study highlights the difference between anecdotal and observational notations versus scientific analysis. Their findings of a non-statistical increase in supracervical approach associated voiding dysfunction as opposed to total abdominal hysterectomy may temper the enthusiasm for the completion of this operation sheerly based on the perception of preventing future voiding dysfunction. As pointed out by the authors, the difficulty in comparing the efficacy of observational studies versus scientific studies is that the former may be performed as an accumulation of experience over a career while the latter may involve a follow-up of significantly less time.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu