Total Versus Subtotal Abdominal Hysterectomy
Total Versus Subtotal Abdominal Hysterectomy
319 Women undergoing hysterectomy for benign (not cancer) indications were randomly allocated
 to 2 types of surgery (Total (TAH) and Subtotal (SAH)) abdominal hysterectomy 15 years ago.
 They were followed by questionnaire at time of surgery and up to 5 years (not yet published)
 after the surgery and evaluated regarding following outcomes: Urinary incontinence, pain,
 bowel problems, per and postoperative complications, sexuality, quality of life, pelvic organ
 prolapse and vaginal bleeding. Now the investigators are conducting a 15 year follow up with
 the same out-come measures but also including physical examinations regarding Urinary
 incontinence, voiding difficulties, pelvic organ prolapse and problems with the cervix. The
 investigators' hypothesis is that several of the out-come measures will be present in more
 cases than earlier due to age and menopausal changes. The investigators expect more urinary
 incontinence in the subtotal group as this was seen at earlier follow ups. The investigators
 expect to find more women with pelvic organ prolapse with the physical examination than by
 questionnaire alone, possibly with a higher incidence in the subtotal group.
The study included women who were offered a hysterectomy for benign uterine disease such as:
 metrorrhagia, menorrhagia, fibroids, endometriosis,and pelvic pain. Women in need of
 hysterectomy for malignant disease or because of prolapse of the uterus were not included.
 They were followed up by a questionnaire covering all outcome measures as described above.
 Background information was registered in a second questionnaire prior to surgery. All
 gynaecological departments in Denmark were invited to join the trial. 11 departments
 contributed randomized patients to the trial.

 the results up to 1 year after surgery have been published, links can be found in the
 citation list. The results from the 5 year follow up have not yet been published.

 The questionnaire used in this trial consists of the validated SF-36 (Short Form 36) quality
 of life questionnaire as well as a thorough questionnaire regarding the outcome measures
 described elsewhere. The entire questionnaire was validated prior to the beginning of the
 trial.

 A second questionnaire has been added in the 15 year follow up: PFDI-20(Pelvic Floor Distress
 Inventory 20). The investigators included this, as it is more thorough regarding pelvic organ
 prolapse and in particular a "bother" measure than the original questionnaire.

 The 20 min. pad-weighing test has been tested against the 1 hour gold-standard used by the
 ICS (International Continence Society) and has been found to give comparable results.
Inclusion Criteria:

 -Women undergoing abdominal hysterectomy for benign uterine disease at a gynaecological
 department in Denmark (15 years ago)

 Exclusion Criteria:

 -  malignant disease

 -  mental disease

 -  diabetes

 -  neurological disease

 -  not able to read and write Danish

 -  pelvic organ prolapse as the reason for hysterectomy

 -  prior surgery for urinary incontinence