Outcomes of Pregnancy Following Surgery for Stress Urinary Incontinence: A Systematic Review

Pollard, Matthew; Morrisroe, Shelby N.; Anger, Jennifer T.

doi:10.1016/j.juro.2012.01.068

Cited by 17 publications

(7 citation statements)

References 27 publications

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“…103 However, the scientific evidence to support this notion, as well as, recommendations to perform an elective caesarean section if pregnancy occurs after a MUS procedure, are based on small case series including sample sizes of 32 to 54 women. [104][105][106][107] The rate of SUI in these series have ranged between 70-80% in women having given birth after MUS surgery. None of the studies included a control group (non-exposed women) and the duration of follow-up was limited.…”

Section: Childbirth After Mid-urethral Sling Surgerymentioning

confidence: 89%

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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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Section: Childbirth After Mid-urethral Sling Surgerymentioning

confidence: 89%

“…Previous studies has shown a SUI prevalence of 20 % in women with childbirth after a MUS procedure. 104,106 A Swedish study on long-term outcomes after MUS procedures, without subsequent deliveries, reported a durable cure rate of up to 90 %. 128 A 10 percentage-points difference could be considered clinically relevant.…”

Section: Power Calculationmentioning

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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“…The original MUS operations were developed and studied in a Nordic co-work [ 12 ], and thus it is likely that similar technique and indications in the Nordic countries explain the comparable results. However, smaller case series from other countries also show MUS to be effective after subsequent childbirth [ 13 – 15 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and delivery after mid-urethral sling operation

et al. 2020

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Introduction and hypotheses There is no consensus regarding pregnancy after mid-urethral sling (MUS) operation, and some clinicians recommend postponing the MUS operation if a woman considers further pregnancies or routinely suggest cesarean section as the delivery method after MUS operations. Our primary aim was to assess the risk for stress urinary incontinence (SUI) re-procedure after delivery in women with a MUS operation prior to pregnancy. We also analyzed SUI re-visits and MUS-related complications during pregnancy and postpartum. Methods We conducted a register-based case-control study of women with a MUS operation in Finland during 1996–2016. We identified 94 cases with a subsequent pregnancy and 330 controls without subsequent pregnancies matched by age, operation type and year. Results The median follow-up time was 10.7 years (IQR 7.1–13.7). The number of SUI re-procedures did not differ between the cases (n = 3, 3.2%) and controls (n = 17, 5.2%; OR 0.6, 95% CI 0.2–2.1). There was no significant difference in re-visits for stress or mixed urinary incontinence between the cases (n = 23, 24.5%) and controls (n = 86, 26.1%; OR 0.9, 95% CI 0.5–1.6), but 35% of the re-visits in the case group occurred already before the delivery after MUS. The rate of vaginal delivery was lower after MUS operation (57%) than in deliveries before MUS (91%, P < 0.001). Conclusions Pregnancy after MUS did not increase the odds for SUI re-procedure or re-visit. Considering on our results, future pregnancy does not need to be viewed as an absolute contraindication for MUS operation.

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“…This showed that 10 of the 12 delivered vaginally and nine of the 11 delivered by caesarean were continent at 2–36 months, giving a recurrence of 20% . A recent systematic review of outcomes of pregnancy following surgery for stress urinary incontinence showed that the incidence of postpartum stress urinary incontinence ranged from 5 to 18% after caesarean delivery and 20 to 30% after vaginal delivery . The authors commented on the limited studies available in the literature, and only in the form of case reports, case series and physicians' surveys, and stated that a formal analysis between the risk after caesarean and vaginal delivery could not be performed with the limited data available.…”

Section: Discussionmentioning

confidence: 99%

Childbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England, 2002–2008

Pradhan

Tincello

Kearney

2012

BJOG

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Objective To report the numbers of patients having childbirth after pelvic floor surgery in England.Design Retrospective analysis of Hospital Episode Statistics data. Main outcome measures Numbers of women having delivery episodes after previous pelvic floor surgery, and numbers having further pelvic floor surgery after delivery.Results Six hundred and three women had a delivery episode after previous pelvic floor surgery in the time period [2002][2003][2004][2005][2006][2007][2008]. In this group of 603 women, 42 had a further pelvic floor surgery episode following delivery in the same time period. The incidence of repeat surgery episode following delivery was higher in the group delivered vaginally than in those delivered by caesarean (13.6 versus 4.4%; odds ratio, 3.38; 95% confidence interval, 1.87-6.10).Conclusions There were 603 women having childbirth after pelvic floor surgery in the time period 2002-2008. The incidence of further pelvic floor surgery after childbirth was lower after caesarean delivery than after vaginal delivery, and this may indicate a protective effect of abdominal delivery.

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Outcomes of Pregnancy Following Surgery for Stress Urinary Incontinence: A Systematic Review

Cited by 17 publications

References 27 publications

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

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

Pregnancy and delivery after mid-urethral sling operation

Childbirth after pelvic floor surgery: analysis of Hospital Episode Statistics in England, 2002–2008

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