Total versus subtotal abdominal hysterectomy influence on the urinary bladder function

ABSTRACT

To evaluate lower urinaiy tract flinctions in asymptomatic patients after subtotal abdominal hysterectomy and total abdominal hysterectomy. Forty mtdtiparous premenopausal patients, subjected to subtotal and total abdominal hysterectomy for non malignant causes, and with no urinary complains, were divided into two groups Group A Twenty patients in whom subtotal abdominal hysterectomy was performed. Group B Twenty patients in whom total abdominal hysterectomy was undertaken. Urodynamic data [cystometry, uroflowmeny, and abdominal detrusor leak point pressure] were collected preoperatively, at the 4[th] week, and at the 4[th] month postoperative in both groups. The mean age of group A and B were 42.58 +/- 12.09 years and 43.9 +/- 13.21 years respectively. The mean parity of group A and B were 2.01 +/- 1 1.08 deliveries and 2.61 +/- 1 1.36 deliveries respectively. The mean body mass index of group A and B were 31.25 +/- 12.85 kg/m[2] and 30.7 +/- 1 3.01 kg/m[2] respectively. There were no statistically significant differences between both groups as regards the age, parity, and body mass index. Four weeks postoperative, patients of group A and B complain of frequency [in 20% and 40%], urgency [in 5% and 25%], urge incontinence[in 5% and 20%] respectively. After 4 months of the operation, frequency persisted in [10% and 25%]; urgency persisted in [5% and 20%], However, urge incontinence disappeared in the only one case of group A, which suffered from, while diminished in group B to 10% of the cases. Stress incontinence had never occurred in both studied groups postoperatively. No statistical significant differences were found in the bladder capacity and detrusor muscle activity preoperatively compared with follow up at 4 weeks and at 4 months postoperatively in both groups. Also, No statistical sign[ficant difference was found in residual urine volume preoperative compared with follow up at 4 weeks and at 4 months postoperatively of group [A]. However, significant postoperative increase in the residual urine volume is observed in patients of group [B]. Insignificant urinary complainsand functions changes, except, urgency and residual urine volume are significantly complicating total hysterectomy more than subtotal hysterectomy, with improvement occurred 4 months after the operation