To assess the risk for stress urinary incontinence (SUI) recurrence and reoperation following a midurethral sling (MUS) procedure in women with a subsequent childbirth and to assess the effect of delivery mode on this risk.
We performed an electronic database search using MEDLINE with the OvidSP interface and PUBMED, Embase, Web of Science and Cochrane Library up to September 20th, 2023.
We included experimental and non-experimental studies, comprising of randomized controlled and observational (case-control, cohort, cross-sectional) studies assessing risk factors for SUI recurrence and reoperation following childbirth in women who had previously undergone a MUS procedure for SUI.
Analysis was conducted using RevMan 5.3 (Cochrane Collaboration, Oxford, UK). Quantitative synthesis was utilized if the included studies were sufficient in numbers and homogeneity. The overall certainty of the evidence was assessed using criteria recommended by the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE).
A total of 2,001 studies were identified of which six were eligible for analysis, comprising 381 patients who had at least one childbirth following a MUS procedure (study group), and 860 patients who underwent a MUS without having a subsequent childbirth (control group). All included studies were observational, the patients' mean age at the time of the MUS procedure ranged from 34 to 36 years and the mean time from MUS procedure to delivery ranged from 21 to 31 months. No differences in SUI recurrence (RR 0.1.02 [95%CI 0.78-1.33]) or reoperation (RR 1.37 [95% CI 0.87-2.17]) were found between the study and control groups. The average follow-up time among the included studies of this comparison was 9.8 years (range 2-18 years). Furthermore, the mode of delivery (vaginal versus cesarean) did not seem to affect the risk for SUI recurrence.
Subsequent pregnancy and childbirth do not seem to increase the risk for SUI recurrence or reoperation following a MUS procedure.
American journal of obstetrics and gynecology. 2023 Nov 28 [Epub ahead of print]
Chen Nahshon, Yoram Abramov, Nir Kugelman, Nadav Cohen, Ofer Lavie, Ariel Zilberlicht
Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address: ., Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.