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Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors.
Int Urogynecol J. 2020 Jun 12 [Online ahead of print]IU

Abstract

INTRODUCTION AND HYPOTHESIS

Debate persists over whether surgery to correct pelvic organ prolapse (POP) should be combined with midurethral sling (MUS) insertion. The aim of this study was to evaluate the incidence of stress urinary incontinence (SUI) up to 12 months after transvaginal mesh surgery, with or without MUS, and to identify risk factors for postoperative SUI.

METHODS

This retrospective single-center study included patients who underwent transvaginal mesh surgery with Uphold™ between October 2010 and December 2017. The primary outcome was the prevalence of SUI at 12 months postoperatively. Univariate and multivariate logistic regression was used to identify risks factors for postoperative SUI.

RESULTS

Of the 308 women included, 123 (40%) were continent (no SUI), 108 (35%) had SUI, and 76 (25%) had occult SUI. Forty-nine patients (15.9%) had a concomitant MUS procedure. At 12 months after surgery, 35.9% of patients without concomitant MUS had SUI vs 14.3% with (p = 0.003). Thirty-five patients (29%) developed de novo SUI. Postoperative complications were more common in patients with concomitant MUS (30.6% vs 17%; p = 0.003). The best predictor of postoperative SUI was the presence of preoperative SUI (OR 2.52 (1.25-5.09). Concomitant MUS (p < 0.001), and prior POP surgery (p = 0.034) were protective factors for postoperative SUI.

CONCLUSION

Preoperative SUI is the most important risk factor for postoperative SUI. However, given the higher risk of postoperative complications with concomitant MUS and the acceptable rate of de novo SUI rate without it, two-stage surgery seems preferable for patients with preoperative SUI.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University Hospital Nîmes, University of Montpellier, Place du Pr Debré, 30029, Nîmes Cedex 9, France. mathilde-bideau@orange.fr.Department of Obstetrics and Gynecology, University Hospital Nîmes, University of Montpellier, Place du Pr Debré, 30029, Nîmes Cedex 9, France.Department of Obstetrics and Gynecology, University Hospital Nîmes, University of Montpellier, Place du Pr Debré, 30029, Nîmes Cedex 9, France. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.Department of Obstetrics and Gynecology, University Hospital Nîmes, University of Montpellier, Place du Pr Debré, 30029, Nîmes Cedex 9, France.Department of Obstetrics and Gynecology, University Hospital Nîmes, University of Montpellier, Place du Pr Debré, 30029, Nîmes Cedex 9, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32533213

Citation

Bideau, Mathilde, et al. "Stress Urinary Incontinence After Transvaginal Mesh Surgery for Anterior and Apical Prolapse: Preoperative Risk Factors." International Urogynecology Journal, 2020.
Bideau M, Allègre L, Callewaert G, et al. Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors. Int Urogynecol J. 2020.
Bideau, M., Allègre, L., Callewaert, G., Fatton, B., & de Tayrac, R. (2020). Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors. International Urogynecology Journal. https://doi.org/10.1007/s00192-020-04363-9
Bideau M, et al. Stress Urinary Incontinence After Transvaginal Mesh Surgery for Anterior and Apical Prolapse: Preoperative Risk Factors. Int Urogynecol J. 2020 Jun 12; PubMed PMID: 32533213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors. AU - Bideau,Mathilde, AU - Allègre,Lucie, AU - Callewaert,Geertje, AU - Fatton,Brigitte, AU - de Tayrac,Renaud, Y1 - 2020/06/12/ PY - 2020/03/20/received PY - 2020/05/22/accepted PY - 2020/6/14/entrez KW - Anterior sacrospinous ligament fixation KW - Pelvic organ prolapse KW - Polypropylene mesh KW - Stress urinary incontinence KW - Vaginal surgery JF - International urogynecology journal JO - Int Urogynecol J N2 - INTRODUCTION AND HYPOTHESIS: Debate persists over whether surgery to correct pelvic organ prolapse (POP) should be combined with midurethral sling (MUS) insertion. The aim of this study was to evaluate the incidence of stress urinary incontinence (SUI) up to 12 months after transvaginal mesh surgery, with or without MUS, and to identify risk factors for postoperative SUI. METHODS: This retrospective single-center study included patients who underwent transvaginal mesh surgery with Uphold™ between October 2010 and December 2017. The primary outcome was the prevalence of SUI at 12 months postoperatively. Univariate and multivariate logistic regression was used to identify risks factors for postoperative SUI. RESULTS: Of the 308 women included, 123 (40%) were continent (no SUI), 108 (35%) had SUI, and 76 (25%) had occult SUI. Forty-nine patients (15.9%) had a concomitant MUS procedure. At 12 months after surgery, 35.9% of patients without concomitant MUS had SUI vs 14.3% with (p = 0.003). Thirty-five patients (29%) developed de novo SUI. Postoperative complications were more common in patients with concomitant MUS (30.6% vs 17%; p = 0.003). The best predictor of postoperative SUI was the presence of preoperative SUI (OR 2.52 (1.25-5.09). Concomitant MUS (p < 0.001), and prior POP surgery (p = 0.034) were protective factors for postoperative SUI. CONCLUSION: Preoperative SUI is the most important risk factor for postoperative SUI. However, given the higher risk of postoperative complications with concomitant MUS and the acceptable rate of de novo SUI rate without it, two-stage surgery seems preferable for patients with preoperative SUI. SN - 1433-3023 UR - https://www.unboundmedicine.com/medline/citation/32533213/Stress_urinary_incontinence_after_transvaginal_mesh_surgery_for_anterior_and_apical_prolapse:_preoperative_risk_factors L2 - https://dx.doi.org/10.1007/s00192-020-04363-9 DB - PRIME DP - Unbound Medicine ER -
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