Reviewer ’s report  
 
Title: Quality of life and the prevalence of urinary incontinence after surgical treatment for  
gynecologic cancer: A questionnaire survey  
 
Version: 0 Date: 20 Aug 2019  
 
Reviewer: Maria Carolina de Toledo  
 
Reviewer's report:  
 
The manuscript shows an important feature of women quality of life after pelvic surgery, 
specially in such a distressed moment of their life: cancer diagno sis and treatment.  
 
Methods:  
Women under 20 years were excluded. It would be interesting to know the reasons that the 
authors did that.  
It is not defined in methods the type of hysterectomy and this is of major importance to know the 
extent of damage in pelvic innervation. So urinary incontinence is higher post -surgery in any 
kind of surgery or would it be associated to the type of surgery ? It is also not mentioned if these 
patients did adjuvant treatment after surgery such as radiotherapy and/or chemotherapy which 
could lead to a higher impairment in pelvic floor function.  
 
Controls:  
This manuscript do not have controls. If I understand we ll the patients answered a questionaire 
about their symptons pre and post -surgery. This leads to some bias: for example; depending on 
time between surgery and answering the questionaire, they could not remember so well their pre -
surgery symptons and even o vervalue their post -surgery symptons. It would be interesting to 
have a prospective study about this with two groups for example: one group with women that 
will be submitted to non -oncological pelvic surgery and a second one with women that will be 
submitt ed to oncological pelvic surgery.  Urinary incontinence is higher after oncologic 
gynecological surgery or after all gynecological surgeries? Urinary incontinence is even higher 
post-surgery or it is similar pre and post -surgery, it is just underdiagnosed?  I believe using 
control groups would clarify these bias.  
 
Results and Conclusions:  
The authors said that urinary incontinence is higher in post -surgery group (52.4% versus 33.8%). 
However when we analyze data from post -surgery group, only 35.4% were reco gnized as having 
urinary incontinence for the first time. So, it seems that the rates are similar between pre and 
post-surgery answers. What is the meaning of these women that comprehend 17%? Did they 
have urinary incontinence pre and post -surgery? If this  is true it is not possible to say that urinary 
incontinence is higher post -surgery in this study. However, for overactive bladder this  difference 
remains, which it is an important fact for clinical pratice and pre -surgery counseling  and it 
should be bet ter discussed.  
 
There is an interesting discussion about the mechanisms that multiple cesarean sections would be 
a risk factor for urinary incontinence in post -surgery. However, a longer period of catheterization 
as risk factor for urinary incontinence shou ld be better discussed. I believe that complicated 
surgeries with more pelvic innervation damage would  lead to more days of bladder 
catheterization. So urinary incontinence would be due to more days of catheterization or more 
damage in pelvic floor functi on? 
 
Quality of written English:  
It would be great some minor corrections in english and phrase structures for better understandig.  
 
It is very important in clinical practice counseling women about post -surgery complications and 
sequels. This manuscript a ttemps to answer these concerns. I believe that after some corrections 
and elucidating some confusing points and bias it would be great to know the findings.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your co mments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially from the publication of this  
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2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
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