Hysterectomy and the risk of urinary incontinence: a systematic review and meta-analysis.

OBJECT: To evaluate the association between hysterectomy and the risk of developing urinary incontinence (UI) based on observational studies.

METHODS

We conducted a systematic search of PubMed, Embase, and Cochrane Library for observational studies from inception to December 14, 2025, using medical subject headings (MeSH) and keywords. The risk of bias and the quality of evidence were assessed using the Newcastle-Ottawa Scale (NOS), the Agency for Healthcare Research and Quality (AHRQ) criteria, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. To derive overall summary estimates of odds ratios (OR), a random-effects meta-analysis was performed, complemented by subgroup analyses to explore potential effect modifiers. And the presence of publication bias was evaluated through funnel plots and Egger's regression test.

RESULTS

This meta-analysis is registered with PROSPERO (CRD42024587774) and follows PRISMA guidelines, including 12 studies with a cumulative total of 146,759 individuals who underwent hysterectomy. The pooled analysis revealed a significant association between hysterectomy and an increased risk of UI, yielding an OR of 1.31, (95% CI: 1.03-1.66, I2 = 88.5%, P = 0.029). Subgroup analyses showed that the risk of UI was notably higher among patients who underwent abdominal hysterectomy (OR = 1.21, 95% CI: 1.10-1.34, I2 = 0.0%, P = 0.000). Furthermore, it was observed that the incidence of UI was particularly elevated in studies conducted in Asia, while no significant association was reported for regions such as Europe and North America.

CONCLUSION

Hysterectomy is associated with an increased risk of urinary incontinence, based on synthesized evidence from observational studies.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42024587774.