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Hysterectomy is a common operation in developed countries, and experts have been arguing for years about possible late side effects including urinary incontinenceincontinence.. The latest evidence comes from a large observational study comparing 165260 women who had a hysterectomy for benign disease with 479506 age matched controls who didn't. Women who had had a hysterectomy were more than twice as likely to need surgery for stress incontinence (hazard ratio 2.4, 95% CI 2.3 to 2.5), particularly in the first five years after surgery. Having children multiplied the risk, which was more than 16 times greater for women having four or more vaginal births. The authors are now fairly certain that hysterectomy causes incontinence, and urge women and their doctors to try less invasive treatments before opting for surgery.
At least one commentator disagrees (p 1462). Despite its size, this observational study simply isn't robust enough to resolve the debate either way, he says. Perhaps hysterectomy does predispose women to later incontinence, but it is just as likely that some other factor is behind both. These authors had no data on smoking or body mass index, for example.