Periurethral Collagen Injection and Pregnancy

Outcomes of pregnancy following surgery for stress urinary incontinence: a systematic review

PURPOSE

Although few data have been published on the safety of childbearing after surgery for stress urinary incontinence, a large proportion of physicians recommend that women wait to complete childbearing before pursuing surgical treatment for stress urinary incontinence. We systematically reviewed the available literature to examine the safety of pregnancy after stress urinary incontinence surgery, and to measure the effect of such pregnancy on continence outcomes.

MATERIALS AND METHODS

The review was conducted according to the recommendations of the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) group. We performed a systematic review to identify articles published before January 2011 on pregnancy after incontinence surgery. Databases searched include PubMed®, EMBASE® and the Cochrane Review. Our literature search identified 592 titles, of which 20 articles were ultimately included in the review.

RESULTS

Data were tabulated from case reports, case series and physician surveys. The final analysis in each category included 32, 19 and 67 patients, respectively. Urinary retention developed during pregnancy in 2 women, 1 of whom was treated with a sling takedown and the other with intermittent catheterization. Of these 2 women 1 also had an episode of pyelonephritis during pregnancy, possibly related to the intermittent catheterization. The incidence of postpartum stress urinary incontinence ranged from 5% to 18% after cesarean delivery and from 20% to 30% after vaginal delivery.

CONCLUSIONS

Although the data on outcomes in the literature are limited and further studies need to be performed on the subject, the current data suggests that any increase in risks for pregnancy after surgery for stress incontinence may be small. A low risk of urinary retention during pregnancy may exist. Although some data suggest that cesarean deliveries may result in a lower rate of recurrent stress urinary incontinence than vaginal deliveries, a formal analysis could not be performed with the available data.

How to advise a woman who wants to get pregnant after a sub-urethral tape placement?

Our objective was to make recommendations for the follow-up of pregnancies and the choice of delivery route for patients becoming pregnant after surgical treatment of stress urinary incontinence (SUI) by tension-free vaginal tape (TVT) or trans-obturator tape (TOT). We performed a retrospective survey on pregnancies after surgical treatment of SUI. Nineteen physicians out of 3,400 contacted reported a total of 20 pregnancies after TVT or TOT. Three patients had recurrent SUI during pregnancy. No major complications of the tape occurred during pregnancy. Ten patients out of 20 delivered vaginally, and nine had a caesarean section. Mean follow-up after delivery was 13.8 months (1 to 52). Recurrence of SUI was observed in 3 of 20 (15%) during pregnancy and in 3 of 18 (16.7%) after delivery. The global rate of recurrence was 4 of 18 (22.2%). Recurrence of SUI was two of ten cases after vaginal delivery (20%) and in one of eight after caesarean section (12.5%; p=0.58). Vaginal delivery did not increase the risk of recurrence.

Cosmetic aspects of pregnancy

There are a vast number of changes to the female body that occur during pregnancy, to which any pregnant woman will attest. The changes, although considered, for the most part, physiological and not pathological, are quite distressing to many women. This chapter serves to review those changes and comment on their physiological origins. Most of these changes can be definitively or inferentially linked to the dramatic hormonal changes that take place to support a pregnancy. Comments are also made about treatment as they pertain to pregnant women. In addition, a brief discussion about performing cosmetic procedures during pregnancy is included.