Stress urinary incontinence (SUI) and endometrial cancer share common risk factors. The surgical treatment of both SUI and endometrial cancer is associated with high success rates and can be performed concomitantly. The aim of this novel study is to describe the clinical and demographic characteristics of women who choose to undergo concurrent anti-incontinence surgery at the time of their hysterectomy for endometrial cancer.

This is a secondary analysis of data from the Cancer of the Uterus and Treatment of Incontinence (CUTI) study. CUTI is a large, multi-site prospective cohort study of women with early stage endometrial cancer or hyperplasia undergoing hysterectomy. At the time of their oncology appointment, women were screened for SUI with the question “Do you leak urine with cough, sneeze, jump or laugh?” Women who answered ‘yes’ were offered enrollment and referral to urogynecology. Women choosing referral to urogynecology were evaluated per standard of care, and depending on clinical diagnosis, were offered treatment for SUI or other pelvic floor disorders at the discretion of the consulting urogynecologist. Validated measures collected from the patients included the Sandvik Severity Index (SSI), Urogenital Distress Inventory (UDI), Incontinence Impact Questionnaire (IIQ) and the Female Sexual Function Index (FSFI). Clinical characteristics and patient-reported outcomes were compared for those choosing concurrent surgical treatment to those who did not.

1,322 women were screened for SUI across eight sites. 702 (53.1%) women screened positive. 556 (79.2%) women enrolled in the CUTI study, 261 (46.9%) opted for urogynecology referral, and 237 completed an evaluation. 102 / 237 (43%) women underwent concurrent surgery. There were no differences in age, race, BMI, insurance status, education, or cancer histology between women choosing concurrent surgery and those who did not. A higher proportion of women choosing concurrent surgery had documented SUI on exam (80.7% vs 19.3%, p<0.0001). Women who chose concurrent surgery had higher UDI scores than those who did not (95.9 vs 81.4, p<0.043). UDI-stress subscale scores were higher for women who chose concurrent surgery (47.5 vs 35.3, p=0.0002), but irritative scores did not differ between groups (32.6 vs 30.9, p=0.55). IIQ scores were not significantly different between the concurrent surgery vs non-concurrent surgery groups (28.1 vs 22.2, p=0.087), respectively. The two most common reasons for not having concomitant surgery were ‘SUI not severe enough’ and ‘Urge-predominant symptoms.’ Only 10 women reported ‘Fear of mesh’ and ‘risk of complications’ as reasons for not choosing concurrent surgery. Ten women underwent prolapse surgery in addition to an anti-incontinence procedure; repair of the posterior compartment was the most common prolapse procedure performed (n=8).

A majority of women with endometrial cancer also report SUI, with nearly 50% choosing evaluation of their urinary leakage prior to their oncology surgery. Clinical findings of SUI and reporting bothersome urinary leakage are associated with choosing concurrent anti-incontinence surgery at the time of hysterectomy for endometrial cancer.

Longer-term comparative outcomes on symptom specific and general quality of life will be important to assess.