Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: A randomized controlled trial with 14-year follow-up

Objective To compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. Study design Long-term follow-up of a randomized clinical trial of subtotal vs. total abdominal hysterectomy with objective outcomes. All randomized women still alive and living in Denmark (n = 304) were invited to answer a questionnaire and come for clinical examination consisting of 20-min pad weighing test, urinary flow, measurement of residual urine, POP-Q measurement for pelvic organ prolapse, 3 day voiding diary and also filled out the pelvic floor distress inventory (PFDI-20) questionnaire. Results We included 100/304 (32.9%) women (subtotal hysterectomy: 53, total hysterectomy: 47) in the clinical examinations. The study questionnaire was answered by 197 (64.8%) (subtotal: 97, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group, 31 (59.6%) women had objective stage 2 pelvic organ prolapse compared with 33 (70.2%) in the total hysterectomy group (P = 0.27); however, only 6/31 and 9/33 had symptoms (P = 0.45). There were more anterior pelvic organ prolapses in the total hysterectomy group (N = 10) than in the subtotal hysterectomy group (N = 4) (P = 0.048). We found a higher mean maximum flow rate (Qmax) in the subtotal hysterectomy group (34.78 ml/s) than in the total hysterectomy group (27.08 ml/s) (P = 0.042) as well as a higher mean functional capacity in the subtotal hysterectomy group (526 ml) than in the total hysterectomy group (443 ml) (P = 0.0147) according to the voiding diary. Conclusion Subtotal and total abdominal hysterectomy are comparable regarding long-term objective pelvic organ prolapse and urinary incontinence. The subtotal hysterectomy group had a higher Qmax and voided volume.