Randomized, controlled trial of total compared with subtotal hysterectomy with 1-year follow-up results

Danish women who were scheduled to undergo hysterectomy for benign disease were invited to participate in a randomized, controlled trial of total versus subtotal hysterectomy. Outcome measures included urinary incontinence, postoperative complications, quality of life, constipation, prolapse of the vaginal top/cervical stump, satisfaction of sexual life, and pelvic pain. Data were obtained from a validated, self-administered, mailed questionnaire that patients completed at enrollment and 2, 6, and 12 months after surgery. Of 319 women who were randomized, 276 participated through the 12-month questionnaire and were included in the analyses. One hundred forty women underwent total abdominal hysterectomy and 136 had subtotal abdominal hysterectomy. After 12 months, more women who had undergone subtotal hysterectomy had urinary incontinence symptoms than those who had total abdominal hysterectomy (13 of 140 [9%] vs. 24 of 136 [18%], P = 0.043). Twenty (14.3%) of the total hysterectomy group and 14 (13.1%) of the subtotal hysterectomy group reported relief of urinary symptoms after surgery. New urinary incontinence symptoms developed in 3 (2.1%) of 140 women randomized to total hysterectomy and 10 (7.6%) of 136 women who had subtotal hysterectomy. Quality-of-life scores improved significantly for each group in both mental and physical measures (P = 0.001 for both). Symptoms of constipation remained unchanged for 25 of 26 patients (19% and 18%) in the total hysterectomy group and for 27 of the 30 women (22% and 20%) in the subtotal hysterectomy group. Sixty-eight percent of women undergoing total hysterectomy reported having a satisfactory sexual life both at entry and at 12 months. The comparable score for those who had the subtotal procedure changed only from 64% to 63%. Three women in the subtotal group developed vaginal prolapse by 12 months. Pelvic pain, which was experienced by over three fourths of the women in each group at entry, persisted in less than one fourth of subjects after surgery. Of 27 women in the subtotal group who continued to have vaginal bleeding, 25 reported weak (n = 8) or very weak (n = 17) bleeding, which was manageable. Two patients found the amount of bleeding intolerable and elected to have the cervical stump removed.