Childbirth after mid-urethral sling surgery: effects on long-term success and complications

Dyrkorn, Ole Aleksander; Staff, Annetine; Kulseng‐Hanssen, Sigurd; Schiøtz, Hjalmar A.; Svenningsen, Rune

doi:10.1007/s00192-019-04067-9

Cited by 12 publications

(4 citation statements)

References 135 publications

(221 reference statements)

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“…Several studies have shown good long-term efficacy rates after MUS operations [19], but they have not reported post-operative hysterectomies. As a secondary result, one study showed a twice higher rate of symptomatic SUI after MUS in women with a subsequent hysterectomy [20]. However, only eight women with a subsequent…”

Section: Discussionmentioning

confidence: 96%

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

Tulokas

Mentula

Härkki

et al. 2022

Arch Gynecol Obstet

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Purpose Hysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse. Methods We included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9–14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence. Results The re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03). Conclusion Hysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.

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Section: Discussionmentioning

confidence: 96%

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

Tulokas

Mentula

Härkki

et al. 2022

Arch Gynecol Obstet

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“…In 2019, one year after our study was published, Dyrkorn et al published a Norwegian study very similar to ours, which allows for interesting comparisons. 166 Their study included 72 women (39 vaginal deliveries, 33 cesarean sections) with and 156 without childbirth after a MUS procedure. The median follow-up time was 10 years after the initial MUS procedure, as compared to 9 years in our study.…”

Section: Study IIImentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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“…Studies have documented good continence outcomes in women who deliver following MUS, and many of these women also experienced satisfactory continence throughout pregnancy. [113][114][115][116] Similarly, one retrospective study on patients with a previous pubovaginal sling demonstrated unchanged incontinence in eight out of nine women post-delivery. 117 Rare complications, such as urinary retention, may occur, with one case study documenting the need for mesh transection during pregnancy due to refractory urinary retention.…”

Section: How Should a Young Woman Who Desires To Have Children In The...mentioning

confidence: 96%

2024 Canadian Urological Association guideline: Female stress urinary incontinence

Carlson,

Andrews,

Bascom

et al. 2024

CUAJ

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prior to publication, this guideline underwent review by the cua guidelines steering committee and expert reviewers. INTRODUCTION & PURPOSEFemale stress urinary incontinence (FSUI) is a common condition that affects approximately 10-20% of the population. 1 It is associated with negative impacts on quality of life (QoL), socialization, and exercise; it has a significant financial impact, and is associated with depression and anxiety. 2 In 2012, the last Canadian Urological Association (CUA) guideline addressing adult urinary incontinence was published; it covered male and female nonneurogenic stress and urgency incontinence. 3 Given the considerable changes in the management of FSUI, and the very distinct considerations and surgical procedures for this group, an individual guideline providing a more detailed overview of this topic was requested by the CUA Guidelines Steering Committee.The specific population this guideline is intended to cover is women over 18 years of age with stress urinary incontinence. This CUA guideline is intended to be used by healthcare providers treating patients with FSUI. The guideline objective is to cover topics important to the evaluation, counselling, non-surgical and surgical treatment of FSUI, and the management of complications of FSUI surgery.Given the significant variation in patients with FSUI, in some sections we focus on the evaluation and management of the "index patient" (similar to other guidelines). 4,5 Other sections are dedicated to specific nonindex patients with FSUI. We recognize that guidelines cannot address the management of all FSUI scenarios. METHODOLOGYWe decided to use a question-and-answer format to provide brief, accessible, and practical answers to common questions addressing the evaluation and management of FSUI. The guideline panel was created to provide representation from a mix of community and academic urologists and allied health professionals from across Canada, in keeping with the CUA guideline rules. Disagreements during the guideline process were resolved by consensus-building. Conflicts of interests for the authors are included at the end of the guideline. The views or interests of the CUA did not influence the final set of recommendations.The guideline panel was led by Dr. Kevin Carlson and Dr. Blayne Welk. The group first met virtually in December 2021. Objectives to guide the development of this document were agreed upon: 1) to be comprehensive without replicating existing evidence reviews; 2) to provide evidence-based and expert-based opinions on relevant topics within FSUI; and 3) to address the unique needs of Canadian urologists where appropriate.All guideline members were asked to submit relevant topics that could be addressed in a questionand-answer format, and the final list of questions was agreed upon by the panel. Further feedback was received from CUA members at the 2022 CUA annual meeting. Individual sections were assigned to members, with another panel member acting as primary reviewer. Members reviewed publications relevant to ...

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Childbirth after mid-urethral sling surgery: effects on long-term success and complications

Abstract: II 2 AIMS OF THE THESIS .

Cited by 12 publications

References 135 publications

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

2024 Canadian Urological Association guideline: Female stress urinary incontinence

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