Hysterectomy is one of the most common gynaecological surgical procedures worldwide, and it is often performed for benign gynaecological conditions such as uterine leiomyomas and dysfunctional uterine bleeding. Hysterectomy can be performed via different surgical approaches including vaginal, open, laparoscopic or robotic-assisted. The type of surgical approach depends on clinical conditions, such as the size of the uterus, the patient's comorbidities and preferences and the surgeon's skills.
Among the urological sequelae and pelvic floor symptoms, hysterectomy has been recognised as one of the potential aetiological factors contributing to urinary dysfunction. Lower urinary tract symptoms (LUTS), particularly urinary incontinence (UI), are one of the postoperative sequelae of hysterectomy. UI is defined as the involuntary leakage of urine from the urethra that occurs when intravesical pressure exceeds urethral closing pressure. In clinical practice, a distinction can be made between stress urinary incontinence (SUI) and urge urinary incontinence (UUI). SUI involves the involuntary loss of urine with effort or exercise, such as sneezing or coughing. UUI is characterised by the involuntary loss of urine accompanied by or immediately preceded by a strong, unexpected and uncontrollable urge to void due to involuntary contractions of the detrusor muscle.
A structured search was conducted to evaluate the clinical impact of different types of non-radical hysterectomy on lower urinary tract symptoms (LUTS) across scientific sources through December 1989 to March 2025, using terms including: ‘urodynamics’, ‘urinary incontinence’, ‘stress incontinence’, ‘urge incontinence’, ‘urinary urgency’, ‘urinary frequency’, ‘urinary nocturia’ and ‘urinary retention’, ‘lower urinary tract symptoms’, ‘hysterectomy’.
Randomised controlled trials and prospective observational studies assessing patients undergoing simple hysterectomy with pre- and post-operative evaluation by validated questionnaires. Exclusion criteria included case reports, reviews, editorials, short communications, radical hysterectomy, post-operative assessment only, non-English publications and studies on pelvic organ prolapse surgery. Ten studies, encompassing 1769 patients, were included in the analysis. Five outcomes were selected: changes in urinary frequency; occurrence of stress urinary incontinence; occurrence of urge urinary incontinence; changes in nocturia; changes in incomplete bladder emptying
Changes from baseline to last follow-up available in urinary frequency (OR 0.48, 95% CI 0.36–0.66; p<0.00001); stress urinary incontinence (OR=0.54, 95% CI 0.44–0.68; p<0.00001); urge urinary incontinence (OR=0.76, 95% CI 0.72–0.94; p=0.01); nocturia (OR 0.55, 95% CI 0.36–0.84; p=0.005); incomplete bladder (OR=0.95, 95% CI 0.66–1.36; p=0.77).
The present meta-analysis demonstrated that simple hysterectomy is associated with a statistically significant reduction in urinary frequency, SUI, UUI and nocturia after surgery. However, adequately powered prospective randomised studies with thorough investigations and symptom assessment using validated questionnaires, along with long-term follow-up, are necessary to evaluate the clinical validity of these findings. This would provide a more comprehensive understanding of the effects of simple hysterectomy on urinary symptoms and its underlying mechanisms.
The present meta-analysis showed that simple hysterectomy is associated with a statistically significant reduction in urinary frequency, stress urinary incontinence, urge urinary incontinence and nocturia after surgery.
Source: Roberta Maria Arseni M.D.; Emanuele De Angelis M.D.; Ilaria Cuccu; BJOG: An International Journal of Obstetrics & Gynaecology, 2025; 0:1–10 https://doi.org/10.1111/1471-0528.70056
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