Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and the Division of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
Obstet Gynecol. 2018 Feb;131(2):297-303. doi: 10.1097/AOG.0000000000002445.
To assess whether subsequent childbirths affect the outcomes of midurethral sling surgery with regard to stress urinary incontinence (SUI).
In this population-based cohort study, we used the validated Swedish nationwide health care registers (the Patient Register and the Medical Birth Register) to identify women with a delivery after midurethral sling surgery (n=207, study group). From the same registers we then randomly identified a control group who had no deliveries after their midurethral sling procedure (n=521, control group). The women in the control group were matched to the women in the study group by age and year of surgery. The Urogenital Distress Inventory and the Incontinence Impact Questionnaire were sent out to the study population. Symptomatic SUI was defined as the primary outcome. Secondary outcomes included the total Urogenital Distress Inventory score, Urogenital Distress Inventory subscale scores, and Incontinence Impact Questionnaire scores.
A total of 728 women were eligible for the study. The response rate was 74%; 163 in the study group (64 with vaginal delivery and 95 with cesarean delivery) and 374 women in the control group were included in the analysis. The rate of SUI (primary outcome) was 36 of 163 (22%) in the study group and 63 of 374 (17%) in the control group. In a multivariate regression analysis of the primary outcome, we found no significant difference between the groups (odds ratio [OR] 1.2, 95% CI 0.7-2.0). Vaginal childbirth after midurethral sling surgery did not increase the risk of SUI compared with cesarean delivery (22% vs 22%, OR 0.6, 95% CI 0.2-1.4). There were no significant differences in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores between any of the groups.
Childbirth after a midurethral sling procedure is not associated with an increased risk of patient-reported SUI, and continence status is not affected by the mode of a subsequent delivery.
评估生育对中尿道吊带术治疗压力性尿失禁（SUI）结局的影响。
在这项基于人群的队列研究中，我们使用经过验证的瑞典全国卫生保健登记处（患者登记处和医疗出生登记处）来确定中尿道吊带手术后分娩的女性（n=207，研究组）。然后，我们从相同的登记处随机选择一组在中尿道吊带手术后没有分娩的对照组女性（n=521，对照组）。对照组的女性按年龄和手术年份与研究组的女性相匹配。向研究人群发送尿生殖窘迫问卷和尿失禁影响问卷。症状性 SUI 被定义为主要结局。次要结局包括总尿生殖窘迫问卷评分、尿生殖窘迫问卷亚量表评分和尿失禁影响问卷评分。
共有 728 名女性符合研究条件。回复率为 74%；研究组 163 名（64 名阴道分娩，95 名剖宫产）和对照组 374 名女性纳入分析。研究组 SUI 发生率（主要结局）为 163 例中的 36 例（22%），对照组为 374 例中的 63 例（17%）。在主要结局的多变量回归分析中，我们发现两组之间无显著差异（比值比[OR] 1.2，95%置信区间[CI] 0.7-2.0）。与剖宫产相比，中尿道吊带手术后阴道分娩不会增加 SUI 的风险（22%比 22%，OR 0.6，95%CI 0.2-1.4）。任何一组之间的尿生殖窘迫问卷和尿失禁影响问卷评分均无显著差异。
中尿道吊带术后分娩不会增加患者报告的 SUI 风险，并且后续分娩方式不会影响尿控状态。
