Pregnancy After Transvaginal Sling for Stress Urinary Incontinence

Adams-Piper, Emily; Darbinian, Jeanne; Postlethwaite, Debbie; Castillo, P.

doi:10.1097/spv.0000000000000096

Cited by 12 publications

(2 citation statements)

References 8 publications

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“…Before the present study, data on the impact of pregnancy and delivery after MUS were limited to small cohort studies and case reports with methodological limitations [94,95,97,171] women with both delivery modes) and a control group of 374 women with no deliveries after MUS [157]. The median interval from primary MUS to followup was nine years, similar to our study.…”

Section: The Impact Of Pregnancy After Mid-urethral Sling Surgerysupporting

confidence: 71%

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

et al. 2019

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Section: The Impact Of Pregnancy After Mid-urethral Sling Surgerysupporting

confidence: 71%

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

et al. 2019

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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: 88%

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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The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid‐urethral sling: A systematic review and metanalysis

Ruffolo,

Lallemant,

Garabedian

et al. 2024

Neurourology and Urodynamics

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IntroductionThere is no guideline or clinical consensus concerning the mid‐urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery.MethodsWe performed a systematic review and meta‐analysis, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis.ResultsRecurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%−26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%−8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73−1.40; p = 0.96 and I2—test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91−2.30; p = 0.12 and I2—test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77‐2.01; p = 0.37 and I2—test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76−3.42; p = 0.22 and I2—test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse.ConclusionChildbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy.

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Pregnancy After Transvaginal Sling for Stress Urinary Incontinence

Abstract: Our case series may suggest that vaginal delivery is not contraindicated and sling-related complications during pregnancy are not prevalent.

Cited by 12 publications

References 8 publications

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

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

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

The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid‐urethral sling: A systematic review and metanalysis

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