Incidence and risk factors of stress urinary incontinence after laparoscopic hysterectomy

Abstract

Objective To observe the long-term effects of total hysterectomy on urinary function, evaluate the effects of preoperative nutritional status, urinary occult infection, and surgical factors on the induction of postoperative stress urinary incontinence (SUI), and explore the incidence and risk factors of SUI. Study design From January 2017 to December 2017, 164 patients with benign non-prolapsing diseases who underwent a laparoscopic total hysterectomy in the First People's Hospital of Taicang were selected as the analysis objects. The International Incontinence Standard Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Pelvic Floor Impact Questionnaire-short version 20 (PFDI-20) were used for telephone follow-up to subjectively assess the urinary function of patients, collect their medical records, and statistically analyze the number of postoperative SUI cases. Logistic multivariate analysis was used to analyze the influencing factors of postoperative female SUI, presented as adjusted odds ratios with 95% confidence intervals. Results Only 97 out of 164 patients completed the ICIQ-FLUTS and PFDI-20 questionnaires. Among these participants, 28 patients (28.86%) were diagnosed with SUI (study group), while 69 patients (71.13%) were classified as women without SUI (control group). The age, menopause, parity ≥ 2 times, Body mass index (BMI) ≥ 28 kg/m2, neonatal weight ≥ 4000 g, history of chronic cough, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, preoperative uterine volume ≥ 90 cm3, intraoperative blood loss, and operation time of the study group were compared with those of the control group. The differences were statistically significant (P < 0.05). Further Logistic multivariate analysis showed that menopause, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, uterine volume ≥ 90 cm3, history of chronic cough, BMI ≥ 28 kg/m2 were risk factors for postoperative SUI in patients undergoing hysterectomy (P < 0.05). Conclusions Hysterectomy for benign non-prolapse diseases has a long-term potential impact on the urinary system of patients, and the risk of postoperative SUI increases. The main risk factors of SUI are parity, menopausal status, obesity, preoperative nutritional status, and occult infection of the urinary system.

Stress Urinary Incontinence: A Ten Years Systematic Review

“…1, displaying patient characteristics based on clinical and UDI diagnoses and details about the cancellation of surgical UI correction after UDI. 11 Considering the Italian National Health System reimbursement of 296.5 € for each UDI, the total cost for the 59 uncomplicated patients in our series was 17,493.5 €. If we take into account the reimbursement by our National Health System, which ranges from 1800-3073 € for each surgical procedure for female SUI (depending on the setting -Day Surgery or hospitalization for two or more days), the total amount saved due to UDI findings ranged from 10,800-18,438 €.…”

“…Data were extracted from an electronic database, and Urodynamic tests adhered to the Good Urodynamic Practice. 11 Clinical Stress Urinary Incontinence (SUI) was diagnosed in 323 out of 544 (59.4%) patients. The prevalence of clinical Pure Stress Urinary Incontinence (P-SUI) was 20.7% (67 out of 323), while the prevalence of complicated SUI (C-SUI) was 79.3% (256 out of 323).…”

“…These savings cover 61.7-105.0% of the costs for the total number of UDIs performed in the uncomplicated patients in our series. 11…”

“…Nonetheless, insurance/health care would have also covered the costs associated with managing negative externalities. 11…”