A total of 382 women were treated at Teine Keijinkai Hospital for cervical, endometrial, ovarian, or peritoneal cancer between April 2008 and October 2013. However, 133 were excluded based on the above exclusion criteria, so the questionnaire survey was sent to 249 women. Of these, responses (together with consent) were received from 145 women (response rate 58.2%), and these 145 women were included in the analysis (Fig. 1).
The mean age at the time of the questionnaire survey was 59.0±12.0 (range 31–89) years, the mean number of inpatient days was 17.2±11.1 (3–56), mean BMI was 23.2±3.8 (14.9–35.0) kg/m2, and the mean period from operation to questionnaire response was 839.6±48.6 (10–2021) days. The numbers of pregnancies, vaginal deliveries, Cesarean sections, and miscarriages (including induced abortions) were 2.2±1.5, 1.6±1.2, 0.2±0.5, and 0.4±0.7, respectively. The diagnosis was cervical cancer in 30.3% (n = 44), endometrial cancer in 40.0% (58), ovarian cancer in 25.5% (37), peritoneal cancer in 2.8% (4), and other disease in 1.4% (2) of respondents. Surgery type was radical hysterectomy in 15.9% (23), modified hysterectomy in 39.3% (57), simple hysterectomy in 15.2% (22), and laparoscopic hysterectomy in 29.7% (43), among which adnexal non-preservation was performed in 81.4% (118), and lymphadenectomy was performed in 60.0% (87) of patients.
1. ICIQ-SF
Among the 145 subjects from whom responses were received, pre-surgical UI was present in 49 (i.e., score ≥3 for Q3+4+5; prevalence 33.8%). On the other hand, post-surgical UI was noted in 76 (52.4%) subjects, among which 34 (35.4%) were recognized as having UI for the first time (Fig. 2). There was a significant difference in the prevalence of UI between pre- and post-surgery. There was no significant difference in age between those with or without UI either pre- or post-surgery.
The frequency and volume scores of UI were 1.4±0.8 and 2.1±0.7, respectively, pre-surgery, while the impact of incontinence on daily life was 1.3±1.4. The scores post-surgery were 1.9±1.5, 2.7±1.7, and 2.3±2.5, respectively, with significant differences between pre- and post-surgery.
Regarding UI classification, of the 49 subjects who had incontinence pre-surgery, 43 had stress incontinence (87.7%), 1 had urge incontinence (2.0%), 5 had mixed incontinence (10.2%), and 0 (0%) had overflow incontinence (Fig. 3). The rate of stress incontinence was significantly greater than that of either urge or mixed incontinence. On the other hand, of the 76 subjects with UI post-surgery, 44 had stress incontinence (57.1%), 6 had urge incontinence (7.8%), 24 had mixed incontinence (31.2%), and 2 (2.6%) had overflow incontinence. The rate of stress incontinence was significantly higher than that of either urge or overflow incontinence. Compared to pre-surgery, the rate of stress incontinence was significantly lower, while the rate of mixed incontinence was significantly higher.
2. OABSS
Seven subjects (4.8%) had OAB based on the OABSS questionnaire responses pre-surgery. However, 19 subjects (13.1%) had OAB post-surgery, including 15 (10.3%) with OAB for the first time. There was a significant difference in the prevalence of OAB between pre- and post-surgery.
3. IIQ–7
The average total score for subjects with UI post-surgery was 6.0±5.6 (out of 21), and the subscale scores were 24.3±25.9 for physical activity, 31.5±32.8 for travel, 32.9±35.9 for social/relationships, and 27.2±29.8 for emotional health (each subscale score out of 100).
4. Factors related to post-operative UI
The logistic regression analysis for the presence/absence of onset of UI post-surgery showed that the number of Cesarean sections (OR 2.4, CI 1.1–5.5) and days of urinary bladder catheterization (OR 1.2, CI 1.1–1.4) were risk factors for postoperative UI.