Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy

Study objective: To assess the incidence of urinary incontinence, bowel dysfunction, and sexual problems after laparoscopic hysterectomy as compared with abdominal hysterectomy. Design: Randomized controlled trial (Canadian Task Force classification I). Setting: Single-center teaching hospital in the Netherlands, experienced in gynecologic minimal access surgery. Patients: Women with a benign or malignant condition scheduled for hysterectomy where vaginal hysterectomy was not feasible and laparoscopic hysterectomy was possible. Interventions: Laparoscopic (n = 38) and abdominal hysterectomy (n = 38). Measurements and main results: Patients were asked before and 3 months after surgery whether they experienced urinary incontinence and completed the validated questionnaires Urogenital Distress Inventory, Incontinence Impact Questionnaire, Defecatory Distress Inventory, and the Questionnaire for screening Sexual Dysfunctions 1 year after surgery. The incidence of urinary incontinence at 3 months after surgery decreased equally in both groups as compared with baseline. De novo urinary incontinence and sexual problems were rare. One year after surgery, a significant treatment effect favoring laparoscopic hysterectomy was found in the Urogenital Distress Inventory and Incontinence Impact Questionnaire, whereas no differences were found in the Defecatory Distress Inventory and Questionnaire for screening Sexual Dysfunctions. Conclusion: Laparoscopic hysterectomy is superior to abdominal hysterectomy with respect to postoperative symptoms of urinary dysfunction.