Hysterectomy is the second most common surgery among women in the U.S.
Review included 60 studies with 3.5+ million participants.
Within 10 years:
Urinary incontinence (effect size 1.29; CI 1.11–1.47)
Stress urinary incontinence (1.31; CI 1.06–1.56)
Overactive bladder (1.41; CI 1.25–1.58)
Mixed urinary incontinence (1.62; CI 1.40–1.85)
After 10 years:
Pelvic organ prolapse (1.56; CI 1.35–1.78)
Stress urinary incontinence (2.40; CI 2.17–2.63)
No consistent evidence for voiding dysfunction, fecal incontinence, or defecatory dysfunction.
Summary
A systematic review and meta-analysis of over 3.5 million women found that hysterectomy for benign conditions is associated with a significantly increased risk of several pelvic floor disorders (PFDs), particularly within 10 years post-surgery.
Within 10 years of hysterectomy, there is higher likelihood of urinary incontinence (effect size 1.29), stress urinary incontinence (1.31), overactive bladder (1.41), and mixed urinary incontinence (1.62); risk of pelvic organ prolapse (POP) rises notably beyond 10 years (effect size 1.56).
The risk of stress urinary incontinence increases dramatically (effect size 2.40) after 10 years post-hysterectomy.
No strong association was found for voiding dysfunction or fecal incontinence; data on long-term outcomes for several PFDs remain limited.
The findings underscore the importance of comprehensive preoperative counseling, including a discussion of these long-term risks alongside alternative options such as medical or organ-preserving treatment, when clinically feasible.
Key Clinical Points
Short-term risks (≤10 years post-surgery): Hysterectomy is linked to higher rates of urinary incontinence (all types), stress urinary incontinence (SUI), overactive bladder (OAB), and mixed urinary incontinence.
Long-term risks (>10 years post-surgery): Increased likelihood of pelvic organ prolapse (POP) and stress urinary incontinence.
Strength of evidence: High for SUI beyond 10 years, moderate for POP beyond 10 years, low to moderate for other outcomes.
Clinical relevance: Counseling before hysterectomy should include discussion of potential long-term pelvic floor disorder risks and consideration of non-surgical options when feasible.
Hysterectomy is linked to a statistically significant increased risk of urinary incontinence (all types) within 10 years, as well as pelvic organ prolapse and stress urinary incontinence beyond 10 years.
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