Hegde Aparna, Huebner Markus, Ibrahim Shaimaa, Mastrolia Salvatore Andrea, David-Montefiore Emmanuel, Weintraub Adi Y
Department of Urogynecology, Cama Hospital, Grant Medical College, Mumbai, India.
Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
Int Urogynecol J. 2024 Jan;35(1):3-17. doi: 10.1007/s00192-023-05630-1. Epub 2023 Oct 5.
The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling.
PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case-control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3.
Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures.
Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD.
本研究的目的是对妊娠和分娩(阴道分娩[VD])或剖宫产(CS)对先前因盆腔器官脱垂(POP)或压力性尿失禁(SUI)接受过盆底重建手术的女性盆底功能障碍复发的影响进行系统评价和荟萃分析,以促进未来基于证据的咨询。
检索1990年至今的PubMed、Cochrane、Embase、BJOG、Scopus等数据库。纳入标准包括队列研究、病例对照研究、病例系列和病例报告,这些研究报告了综述的主要结局指标。排除标准包括对手术操作的研究,其结果不太可能受到妊娠和分娩的影响或已过时。使用Review Manager 5.3进行荟萃分析。
七篇关于中段尿道吊带术(MUS;VD组和CS组各181名女性)的论文和三篇关于不同子宫托技术的论文(VD组和CS组分别为47名和29名女性)被纳入荟萃分析。对于先前接受过MUS手术的女性,两组在SUI复发方面无差异(比值比[OR]:1.18[0.66,2.09];Z=0.56;p=0.58),在使用各种顶端悬吊手术进行子宫托术后POP复发方面也无差异(OR:1.81[0.04,80.65];Z=0.31;p=0.76)。没有足够的数据支持对个体MUS亚型或子宫托手术进行荟萃分析。
当前文献未证明剖宫产对接受SUI的MUS手术的女性预防SUI复发具有保护作用。无论采用何种顶端悬吊手术,剖宫产和阴道分娩后POP复发的发生率似乎相似。