We read with interest the article of Bohlin et al about urinary incontinence (UI) after hysterectomy. Based on a large cohort study, the authors stated that several factors, including vaginal delivery, body mass index, and preoperative urgency, influenced the rate of UI after hysterectomy. However, the authors did not underline the confusion made between urge UI (UUI) and stress UI (SUI). It is mandatory to comment on this point, because the absence of distinction between UUI and SUI can be misleading for several reasons.

First, distinguishing SUI and UUI (and their association, called mixed incontinence) is of importance because both are highly prevalent and often associated. The prevalence of overactive bladder (OAB), ie, urgency with or without incontinence, is estimated to be 11.8%, varying from 1.8-30.5% in a recent article by Milsom et al. Separating SUI and UUI would thus have led to groups of similar size based on patient characteristics and would have likely influence the results in a logistic regression analysis.

Then, the pathophysiology of UUI and SUI is completely different, as are the therapeutic resources. While SUI has a complex but known interaction with pelvic organ prolapse, UUI belongs to the field of OAB and has very unclear links with pelvic organ prolapse and other gynecologic disorders, based on low-level inconsistent evidence.

Lastly, the authors consider “daily urge” as a criterion in their logistic regression analysis. As a component of OAB, but not necessarily associated with UUI, this parameter cannot be interpreted correctly in the current context. Indeed, this category can reflect OAB without incontinence, that is idiopathic in the vast majority of cases and would not be impacted by hysterectomy. On the other hand, this category of “daily urge” surely includes all patients with UUI, but their proportion can only be postulated. Unfortunately, this “daily urge” status is not available in the postoperative setting. Furthermore, the absence of data regarding antimuscarinic therapy is also another important caveat.

Not taking into account that UUI and SUI are 2 different diseases blurs the analysis and limits sound conclusions.