The Impact of Non-Radical Hysterectomy on Urinary Functions: Evaluation of Symptoms-A Systematic Review and Meta-Analysis.

Abstract

Simple hysterectomy is one of the most common gynaecological surgical procedures worldwide; however, its association as a possible aetiological factor for urinary dysfunction remains controversial. To evaluate the clinical impact of different types of non-radical hysterectomy on lower urinary tract symptoms (LUTS). A structured search was conducted 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 suggests that simple hysterectomy is associated with a reduction in the prevalence of urinary symptoms postoperatively. PROSPERO: CRD42024575574.