Intrafascial versus extrafascial abdominal hysterectomy: effects on urinary urge incontinence

Our aim was to evaluate urinary urge incontinence following intrafascial and extrafascial abdominal hysterectomies in a prospective randomized study. Women scheduled for total abdominal hysterectomy were randomized to the extrafascial (n=38) and the intrafascial techniques (n=42). The groups were controlled for demographic variables, obstetric and gynecologic history, uterine size, indications for hysterectomy, and preoperative hemoglobin values. Short-term surgical morbidity and presence of urge incontinence defined as urodynamically established detrusor overactivity at the end of 12 months were the main outcome measures. Major surgical morbidity did not differ between the two groups. Percentages of women with urge incontinence at the end of the follow-up period were also similar. However, when women with pre-existing urge incontinence were evaluated separately, there was a trend towards the intrafascial operation to be associated with more urge-incontinence-free patients at the end of the follow-up period ( p=0.06, borderline significant). As a result, short-term surgical morbidity seems to be similar across the intrafascial and extrafascial techniques of abdominal hysterectomy. The effects of intrafascial abdominal hysterectomy on women presenting with urge incontinence in the preoperative period merit further investigation.