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Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors

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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.

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References

  1. Slieker-ten Hove MCP, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-Theunissen RPM, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1037–45.

    Article  Google Scholar 

  2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.

    Article  CAS  Google Scholar 

  3. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:CD012079.

    PubMed  Google Scholar 

  4. Baessler K, Christmann-Schmid C, Maher C, Haya N, Crawford TJ, Brown J. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8:CD013108.

    PubMed  Google Scholar 

  5. Van der Ploeg JM, Oude Rengerink K, van der Steen A, van Leeuwen JHS, van der Vaart CH, Roovers J-PWR, et al. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial. Int Urogynecol J. 2016;27:1029–38.

    Article  Google Scholar 

  6. Lo T-S, Pue LB, Tan YL, Hsieh W-C, Kao CC, Uy-Patrimonio MC. Anterior-apical single-incision mesh surgery (uphold): 1-year outcomes on lower urinary tract symptoms, anatomy and ultrasonography. Int Urogynecol J. 2019;30:1163–72.

    Article  Google Scholar 

  7. Altman D, Mikkola TS, Bek KM, Rahkola-Soisalo P, Gunnarsson J, Engh ME, et al. Pelvic organ prolapse repair using the uphold™ vaginal support system: a 1-year multicenter study. Int Urogynecol J. 2016;27:1337–45.

    Article  Google Scholar 

  8. Allègre L, Debodinance P, Demattei C, Fabbro Peray P, Cayrac M, Fritel X, et al. Clinical evaluation of the uphold LITE mesh for the surgical treatment of anterior and apical prolapse: a prospective, multicentre trial. Neurourol Urodyn. 2019;38:2242–9.

    Article  Google Scholar 

  9. Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.

    Article  CAS  Google Scholar 

  10. Baessler K, Maher C. Pelvic organ prolapse surgery and bladder function. Int Urogynecol J. 2013;24:1843–52.

    Article  Google Scholar 

  11. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.

    Article  Google Scholar 

  12. De Tayrac R, Faillie J-L, Gaillet S, Boileau L, Triopon G, Letouzey V. Analysis of the learning curve of bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair. Eur J Obstet Gynecol Reprod Biol. 2012;165:361–5.

    Article  Google Scholar 

  13. Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanssen S. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J. 2010;21:179–86.

    Article  Google Scholar 

  14. Lensen EJM, Withagen MIJ, Kluivers KB, Milani AL, Vierhout ME. Urinary incontinence after surgery for pelvic organ prolapse. Neurourol Urodyn. 2013;32:455–9.

    Article  Google Scholar 

  15. Alas AN, Chinthakanan O, Espaillat L, Plowright L, Davila GW, Aguilar VC. De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence. Int Urogynecol J. 2017;28:583–90.

    Article  Google Scholar 

  16. Kasturi S, Diaz SI, McDermott CD, Woodman PJ, Bump RC, Terry CL, et al. De novo stress urinary incontinence after negative prolapse reduction stress testing for total vaginal mesh procedures: incidence and risk factors. Am J Obstet Gynecol. 2011;205:487.e1–4.

    Article  Google Scholar 

  17. Jundt K, Wagner S, von Bodungen V, Friese K, Peschers UM. Occult incontinence in women with pelvic organ prolapse—does it matter? Eur J Med Res. 2010;15:112–6.

    Article  CAS  Google Scholar 

  18. Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, et al. Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol. 2008;112:49–55.

    Article  Google Scholar 

  19. Oride A, Kanasaki H, Hara T, Kyo S. Postoperative outcomes following tension-free vaginal mesh surgery for pelvic organ prolapse: a retrospective study. Urol J. 2019;16:581–5.

    PubMed  Google Scholar 

  20. Lapitan MCM, Cody JD, Mashayekhi A. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD002912.

    PubMed  Google Scholar 

  21. Dean N, Ellis G, Herbison GP, Wilson D, Mashayekhi A. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD002239.

    PubMed  Google Scholar 

  22. Brown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet. 2000;356:535–9.

    Article  CAS  Google Scholar 

  23. Longo PS, Borbily LV, Glina FPA. Urinary incontinence following subtotal and total hysterectomy: a systematic review. Einstein (Sao Paulo). 2019;17:eRW4320.

    Article  Google Scholar 

  24. Lo T-S, Bt Karim N, Nawawi EA, Wu P-Y, Nusee Z. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogynecol J. 2015;26:1313–9.

    Article  Google Scholar 

  25. Tran H, Chung DE. Incidence and management of de novo lower urinary tract symptoms after pelvic organ prolapse repair. Curr Urol Rep. 2017;18:87.

    Article  Google Scholar 

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Funding

The authors received no funding for this study.

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Author notes

  1. Mathilde Bideau, Lucie Allègre, and Geertje Callewaert contributed equally to this work

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital Nîmes, University of Montpellier, Place du Pr Debré, 30029, Nîmes Cedex 9, France

    Mathilde Bideau, Lucie Allègre, Geertje Callewaert, Brigitte Fatton & Renaud de Tayrac

  2. Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium

    Geertje Callewaert

Authors
  1. Mathilde Bideau
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  2. Lucie Allègre
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  3. Geertje Callewaert
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  4. Brigitte Fatton
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  5. Renaud de Tayrac
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Contributions

M. Bideau, G. Callewaert, and L. Allègre contributed equally to this work and should be considered as joint first authors. They were involved in data analysis and manuscript writing. B. Fatton was involved in project/protocol development and data collection. De Tayrac was the principal investigator during the clinical trial and was involved in project/protocol development, data collection, and manuscript writing. All authors reviewed and/or edited the manuscript prior to submission.

Corresponding author

Correspondence to Mathilde Bideau.

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Financial disclaimers/conflicts of interest

R. de Tayrac is a consultant for Boston Scientific, has received research funding from Sofradim/Covidien and Boston Scientific, and speaker honoraria from Boston Scientific, Coloplast, and American Medical System. B. Fatton is a consultant for Boston Scientific. M. Bideau, L. Allègre, and G. Callewaert declare that they have no conflicts of interest.

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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 32, 111–117 (2021). https://doi.org/10.1007/s00192-020-04363-9

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  • DOI: https://doi.org/10.1007/s00192-020-04363-9

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