Alessandro Ferdinando Ruffolo, Marine Lallemant, Charles Garabedian, Aurore Deseure, Yohan Kerbage, Chrystèle Rubod, Michel Cosson
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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.</p><p><strong>Methods: </strong>We 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.</p><p><strong>Results: </strong>Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I<sup>2</sup> = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I<sup>2</sup> = 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 I<sup>2</sup>-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I<sup>2</sup>-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 I<sup>2</sup>-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I<sup>2</sup>-test of 0% p = 0.47). BMI ≥ 30 kg/m<sup>2</sup>, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse.</p><p><strong>Conclusion: </strong>Childbirth 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.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis.\",\"authors\":\"Alessandro Ferdinando Ruffolo, Marine Lallemant, Charles Garabedian, Aurore Deseure, Yohan Kerbage, Chrystèle Rubod, Michel Cosson\",\"doi\":\"10.1002/nau.25485\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>There 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.</p><p><strong>Methods: </strong>We 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.</p><p><strong>Results: </strong>Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I<sup>2</sup> = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I<sup>2</sup> = 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 I<sup>2</sup>-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I<sup>2</sup>-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 I<sup>2</sup>-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I<sup>2</sup>-test of 0% p = 0.47). BMI ≥ 30 kg/m<sup>2</sup>, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse.</p><p><strong>Conclusion: </strong>Childbirth 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.</p>\",\"PeriodicalId\":19200,\"journal\":{\"name\":\"Neurourology and Urodynamics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurourology and Urodynamics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/nau.25485\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/5/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurourology and Urodynamics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/nau.25485","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/10 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
导言：关于压力性尿失禁（SUI）的尿道中段吊带（MUS）手术和未来妊娠，目前尚无相关指南或临床共识。本系统综述和荟萃分析旨在评估妊娠和分娩对曾接受过 MUS 手术的女性 SUI 的影响：我们根据《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）2020 指南进行了系统综述和荟萃分析，并选择了七篇文献纳入分析：在纳入的研究中，曾接受过MUS治疗的女性产后SUI复发率为22%（95%置信区间[CI]：18.0%-26.0%；I2 = 0%），而SUI的再次干预率为5%（95% CI：2.0%-8.0%；I2 = 47.34%）。经 MUS 分娩（阴道分娩和剖腹产）或未经 MUS 分娩的妇女在 SUI 复发率（RR 1.01，95% CI 0.73-1.40；P = 0.96，I2 检验为 41%，P = 0.18）和 SUI 再干预率（RR 1.45，95% CI 0.91-2.30；P = 0.12，I2 检验为 0%，P = 0.38）方面没有统计学意义上的显著差异，各研究之间具有同质性。阴道分娩或剖腹产妇女的 SUI 复发率（RR 1.24，95%CI 0.77-2.01；P = 0.37，I2 检验为 0%，P = 0.60）和再干预率（RR 1.61，95%CI 0.76-3.42；P = 0.22，I2 检验为 0%，P = 0.47）均无差异。BMI≥30 kg/m2、孕前和孕期尿失禁（UI）是产后尿失禁复发的风险因素：结论：分娩不会影响曾接受过 MUS 治疗的妇女的 SUI 复发或再干预。在相同的患者群体中，分娩方式对尿失禁复发或再干预结果的影响没有明显差异。曾接受过MUS手术的妇女在随后的妊娠中可能不适合剖宫产。
The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis.
Introduction: There 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.
Methods: We 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.
Results: Recurrence 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.
Conclusion: Childbirth 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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