Changes in vesicourethral function following laparoscopic hysterectomy versus abdominal hysterectomy

Abstract

OBJECTIVE: To assess whether total hysterectomy is associated with increased postoperative vesicourethral abnormalities. SAMPLE: Forty-five patients had a laparoscopic hysterectomy and 36 patients had a total abdominal hysterectomy. DESIGN: Before and after hysterectomy, patients underwent a urinalysis, a personal interview, and an urodynamic study. RESULTS: Of the laparoscopic hysterectomy group, 27 patients (60%) exhibited urinary symptoms preoperatively, and 22 patients (48.9%) remained symptomatic following surgery. There was no significant change in the number of women with one or more urinary symptoms, but the incidence of urinary frequency and stress incontinence decreased significantly following hysterectomy (p < 0.05). Of the total abdominal hysterectomy group, preoperative voiding symptoms were present in 22 patients (61.1%). After surgery, urinary symptoms were present in 19 patients (52.8%). Some patients did not complain of any urinary frequency or stress incontinence following hysterectomy, but this figure did not differ significantly (p > 0.05). Maximal urethral closure pressure and maximal cystometric capacity demonstrated significant increases for both groups following surgery. CONCLUSIONS: The results indicated that total hysterectomy, either laparoscopic or total abdominal hysterectomy, did not significantly increase the subjective and objective incidence of vesicourethral dysfunction. On the contrary, some patients experience a substantial improvement of pre-existing urinary frequency or stress incontinence, partly as a result of an increase in the maximal urethral closure pressure and total bladder capacity following hysterectomy.