A recent study published in the American Journal of Obstetrics & Gynecology suggests that the likelihood of recurrence of stress urinary incontinence (SUI) is not increased by future pregnancy and childbirth.
Worldwide, SUI affects 20% to 25% of women, having a negative effect on their quality of life. The suggested procedure, with up to 85% success rate, is the midurethral sling procedure (MUS).
Because they are worried about a second SUI, clinicians frequently advise patients who are considering a pregnancy to postpone surgical treatment. After a previous MUS operation, many also advise cesarean delivery over vaginal delivery. The possibility of recurrent SUI following a MUS surgery, however, is not well understood.
To assess the relationship between the MUS operation and the likelihood of SUI recurrence in a subsequent pregnancy, researchers carried out an extensive meta-analysis. MEDLINE, Embase, Pubmed, the Cochrane Library, and Web of Science are among the databases analyzed for literature up to September 20, 2023.
The analysis includes observational and randomized controlled trials assessing the likelihood of SUI recurrence in pregnant patients following MUS surgery. Included were studies comparing the risks of vaginal versus cesarean delivery.
Two impartial reviewers independently screened the title, abstract, and complete text; differences were settled by conversation. A third reviewer was included in the conversation if necessary.
The two main outcomes that were assessed were SUI recurrence following childbearing and SUI reoperation following childbirth. The effect of delivery modality on SUI recurrence and reoperation rates were secondary outcomes. The Risk of Bias instrument developed by the Cochrane Collaboration was used to assess bias risk.
Six trials totaling 381 patients who gave birth following a MUS procedure and 860 women who did not give birth following MUS were included in the study. In the study group, 182 individuals had vaginal deliveries, 195 had cesarean deliveries, and 4 had both.
Patients were between the ages of 21 and 31 months on average between the MUS surgery and delivery, with an average age of 34 to 36 years. There was a reported average follow-up period of 9.8 years.
women who had given birth had a higher chance of experiencing an SUI recurrence after MUS (17% to 24%) compared to women who had not given birth (15% to 22%). With a risk ratio (RR) of 1.02, this difference was not statistically significant.
At 1.37, the RR was likewise not significant for reoperation. Furthermore, there was no difference in the rates of SUI recurrence and reoperation between patients who had vaginal and cesarean deliveries, with RRs of 1.81 and 1.43, respectively.
These findings suggested that among women who had previously undergone a MUS, a subsequent delivery does not raise the likelihood of an SUI recurrence or reoperation. In order to confirm or deny these results, investigators suggested conducting carefully planned prospective randomized investigations.
