Comparison of urodynamic outcomes by hysterectomy technique: A cross-sectional study.

Abstract

Although hysterectomy significantly alters pelvic anatomy, its long-term effects on bladder function, pelvic floor integrity, and urethral sphincter activity remain controversial. Previous studies have reported inconsistent findings, often limited by surgical variability, heterogeneous study populations, and differing definitions of detrusor hypocontractility. This study aimed to determine whether urodynamic results-specifically, detrusor contractility, urethral sphincter function, and pelvic floor function-differ according to hysterectomy technique. We conducted a retrospective, single-center, cross-sectional analysis of urodynamic studies from women who underwent abdominal, vaginal, or laparoscopic hysterectomy in Mexico between 2019 and 2024. Standardized thresholds derived from established urodynamic references were used to evaluate detrusor function, sphincter strength, and pelvic floor integrity. ANOVA, Kruskal-Wallis, and chi-square tests were applied (p < 0.05). Among 172 women, 124 (72.1%) underwent abdominal hysterectomy, 40 (23.2%) vaginal, and 8 (4.6%) laparoscopic. No significant differences were found in pelvic floor function or urethral pressure profile across surgical types. However, patients undergoing vaginal hysterectomy more frequently demonstrated urodynamic findings consistent with detrusor hypocontractility, with lower Qmax and detrusor contraction index values. This is the first study to directly compare urodynamic parameters across hysterectomy techniques. Vaginal hysterectomy was associated with a higher prevalence of urodynamic findings consistent with detrusor hypocontractility, whereas urethral and pelvic floor function remained unaffected by surgical approach. Although the observed association does not imply causality, these findings support further investigation of the relationship between hysterectomy technique and postoperative bladder function, particularly in patients for whom vaginal hysterectomy is considered and who have known risk factors for detrusor hypocontractility.