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The following is a summary of “Associations between hysterectomy and pelvic floor disorders: a systematic review and meta-analysis,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by Chang et al. 

Researchers conducted a retrospective study to examine the associations between hysterectomy and the likelihood of pelvic floor disorders (PFDs).  

They systematically searched Medline and Embase from inception to October 11, 2024, without language restrictions and registered the review in PROSPERO (CRD42023443210). Randomized controlled and non-randomized comparative studies with adjusted analyses were included, focusing on adult female individuals (≥18 years) who underwent hysterectomy for benign indications with at least 1 year of follow-up. Studies involving concomitant PFD surgeries were excluded, 12 investigators independently screened abstracts and full texts in duplicate. Data extraction, risk of bias assessment, and evidence grading followed standard instruments. Meta-analyses used random-effects models, evaluating pelvic organ prolapse (POP), urinary incontinence (non-specific, mixed, stress), overactive bladder, voiding dysfunction, fecal incontinence, and defecatory dysfunction, with outcomes stratified by time since hysterectomy (≤10 years vs. >10 years).  

The results showed that 60 studies (8 randomized controlled trials (RCTs), 20 cohort studies, and 32 case-control studies) with 35,67,848 participants were included. Within 10 years, hysterectomy was linked to an increased likelihood of (non-specific) urinary incontinence (effect size [ES] 1.29, 95% CI 1.11 to 1.47; 25 studies), stress urinary incontinence (SUI) (ES 1.31, 95% CI 1.06 to 1.56; 14 studies), overactive bladder (ES 1.41, 95% CI 1.25 to 1.58; 16 studies), and mixed urinary incontinence (ES 1.62, 95% CI 1.40 to 1.85; 3 studies). After 10 years, hysterectomy was associated with a higher likelihood of POP (ES 1.56, 95% CI 1.35 to 1.78; 6 studies) and SUI (ES 2.40, 95% CI 2.17 to 2.63; 5 studies).  

Investigators concluded that hysterectomy increases the risk of urinary incontinence and POP. 

Source: ajog.org/article/S0002-9378(25)00164-4/abstract