A Proximal Straining Mesh Location Is Associated With De Novo Stress Urinary Incontinence After Transobturator Mesh Procedures

Determining the risk factors and characteristics of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery: A systematic review

OBJECTIVE

Stress urinary incontinence (SUI) is a common problem in women that affects their quality of life. According to the current evidence, 15%-50% of severe pelvic organ prolapse (POP) surgeries lead to de novo urinary incontinence (UI). This study aimed at determining the risk factors and characteristics of de novo SUI after POP surgeries in a systematic review.

MATERIAL AND METHODS

We conducted a systematic search of articles in English related to the risk of UI after POP surgery published until December 2019 in the selected bibliographic databases, including PubMed, EMBASE, Scopus, Cochrane Library, and ProQuest.

RESULTS

The initial search resulted in 2,363 studies, and after reviewing the titles and abstracts, 146 studies were identified. Moreover, 2 independent reviewers, using the Joanna Briggs Institute checklists, evaluated the risk of biases in the selected studies. Finally, 40 studies met the inclusion criteria. The most important predictors of UI after POP surgery were positive pessary testing, age >50 years, and maximum urethral closure pressure (MUCP) <60 cmH₂O.

CONCLUSION

Positive pessary testing, older age, and low MUCP were the most important risk factors for de novo incontinence after POP surgeries.

Predictors for de novo stress urinary incontinence following pelvic reconstructive surgery with mesh

OBJECTIVE

The aims of this study are to describe the postoperative incidence of de novo stress urinary incontinence (SUI) in women who underwent anterior vaginal compartment prolapse repair using synthetic polypropylene mesh and to identify risk factors for this outcome.

STUDY DESIGN

A retrospective cohort study of 146 women who underwent anterior vaginal repair from 2007 to 2017 and followed by a minimum period of 12 months was performed. The incidence of de novo SUI was evaluated at 3 and 12 months of follow-up. Women with concomitant or prior anti-incontinence surgery were not included. Preoperatively, all patients had a negative stress test and no evidence of occult SUI on urodynamics. The outcome was considered positive if the patient had complaints of SUI at the follow-up. Variables associated with the outcome with a p-value ≤ 0.10 were included in a logistic regression model to calculate the relative risk (RR) for de novo SUI. For multivariate analysis, all analyzes were performed considering a significant p-value ≤ 0.05.

RESULTS

The incidence of de novo SUI at 3 and 12 months of follow-up was 15.8 % and 20.5 %, respectively. Higher body mass index (BMI), diabetes, anterior vaginal wall prolapse stage ≥ 3, older age at first pregnancy and higher first desire to void during the urodynamic evaluation were positively associated with de novo SUI in the bivariate analysis (p ≤ 0.10). Previous perineoplasty had a negative association with the outcome analyzed, suggesting a protective effect. After the multivariate analysis, higher BMI (RR 1.19, 95 % confidence interval [CI] 1.05-1.36), diabetes (RR 4.18, 95 % CI 1.32-13.21) and anterior vaginal wall prolapse stage ≥ 3 (RR 14.74, 95 % CI 1.64-132.0) remained as risk factors for de novo SUI (p ≤ 0.01).

CONCLUSION

The incidence of de novo SUI after the surgical correction of anterior vaginal wall prolapse with synthetic mesh in this population was 15.8 % and 20.5 % at 3 and 12 months of follow-up, respectively. Continent women who underwent this surgical procedure and who had a higher BMI, diabetes and anterior vaginal wall prolapse stage ≥ 3 had a higher risk of presenting de novo SUI.

Medium-term outcomes for primary native tissue reconstructive surgeries with and without transobturator vaginal meshes in stress continent women with stage 3 or higher pelvic organ prolapse

AIMS

To compare the surgical outcomes of conventional surgeries with or without concomitant transobturator vaginal mesh (TVM) for ≥Stage 3 pelvic organ prolapse (POP).

METHODS

We retrospectively investigated 166 women who received conventional surgery including vaginal total hysterectomy, modified McCall culdoplasty, and AP-repair (conventional group) and 98 women with concomitant TVM (mesh group). Follow-up at 3, 12, and 24 months comprised symptom interview, pelvic examination, and ultrasound assessments. The primary outcome was anatomical success defined as ≤Stage 1 POP. Secondary outcomes were subjective symptoms, ultrasound manifestations, and complications.

RESULTS

Both groups showed improvements in functional and anatomical outcomes after operations. Compared with the conventional group, the mesh group had higher rates of de novo stress urinary incontinence (SUI) at 3-month (3.6% vs 19.4%; P < .001), 12-month (3.7% vs 26.4%; P < .001), and 24-month (2.4% vs 21.4%; P = .001) follow-up, a higher POP-C point (-7.3 ± 0.7 cm vs -7.6 ± 0.6 cm; P < .001) at 3-month follow-up, a smaller straining bladder neck angle indicating a more cranioventral straining bladder neck position (117 ± 25° vs 102 ± 20°; P < .001) at 3-month follow-up, and a less bladder neck mobility at 3-month (19 ± 24° vs 8 ± 14°; P = .002) and 12-month (26 ± 18° vs 12 ± 15°; P = .003) follow-up.

CONCLUSIONS

Concomitant TVM is associated with a higher rate of de novo SUI, more cranioventral straining bladder neck position, and less bladder neck mobility.