Previous obstetrical history does not impact short-term mid-urethral sling outcomes

Ole Aleksander Dyrkorn,Anne Cathrine Staff,Rune Svenningsen,Sigurd Kulseng-Hanssen

doi:10.1007/s00192-021-04836-5

Abstract

Introduction and hypothesisPregnancy and delivery are known risk factors for stress and mixed urinary incontinence. The most common surgical treatment is mid-urethral sling (MUS) surgery. This study evaluated the potential impact of the obstetrical history on the short-term subjective and objective failure rates after MUS surgery.MethodsA registry-based surgical cohort study using data from the Medical Birth Registry of Norway (MBRN) and the national Norwegian Female Incontinence Registry (NFIR). Data from 14,787 women that underwent MUS surgery from 1998 to 2016 with complete registrations in the MBRN were included. Outcomes were 6–12-month postoperative subjective and objective failure rates. The potential impact of obstetrical and constitutional factors on both outcomes was tested in a multivariate logistic regression model.ResultsSeveral obstetrical variables seemed to impact both outcomes in the univariate analyses. However, in the multivariate analyses, none of the obstetrical variables significantly impacted subjective failure, and only being nulliparous before MUS surgery remained a risk factor for objective failure [aOR 1.60, (95% CI 1.07–2.40), p = 0.022]. High body mass index at time of surgery, non-retropubic slings, high preoperative urgency symptom load, and surgical complications were all strong risk factors for poor outcomes in the multivariate analyses.ConclusionAlthough childbirth is considered a risk factor for developing stress urinary incontinence, childbirth does not appear to affect the result of MUS in parous women. Our results suggest that nulliparous women with SUI may have a different pathophysiology than SUI after childbirth.

Highlights

Introduction and hypothesisPregnancy and delivery are known risk factors for stress and mixed urinary incontinence
Conclusion childbirth is considered a risk factor for developing stress urinary incontinence, childbirth does not appear to affect the result of mid-urethral sling (MUS) in parous women
Our results suggest that nulliparous women with Stress urinary incontinence (SUI) may have a different pathophysiology than SUI after childbirth

Summary

Introduction

Pregnancy and delivery are known risk factors for stress and mixed urinary incontinence. Female urinary incontinence (UI) is the most prevalent longterm pelvic floor disorder with a substantial negative impact on women’s quality of life, productivity, socializing, and sexuality [1, 2]. Stress urinary incontinence (SUI), defined as involuntary loss of urine on physical exertion, sneezing, or coughing [3], affects approximately 15% of the female population, with the highest prevalence found in women between 25 and 49 years of age [1]. There is an ongoing debate regarding the possible long-term effects of pregnancy itself on later pelvic floor dysfunction and the additive effects of vaginal delivery in combination with other risk factors, such as birth weight, operative vaginal delivery and maternal age. There is some evidence of a protective effect on pelvic floor function from cesarean delivery in the short term compared to vaginal delivery, but long-term protection has been questioned [4, 5, 9]

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