The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis

Alessandro Ferdinando Ruffolo; Marine Lallemant; Charles Garabedian; Aurore Deseure; Yohan Kerbage; Chrystèle Rubod; Michel Cosson

doi:10.1002/nau.25485

The impact of pregnancy and childbirth on stress urinary incontinence in women previously submitted to mid-urethral sling: A systematic review and metanalysis

Neurourol Urodyn. 2024 May 10. doi: 10.1002/nau.25485. Online ahead of print.

Authors

Alessandro Ferdinando Ruffolo¹, Marine Lallemant¹, Charles Garabedian¹, Aurore Deseure¹, Yohan Kerbage¹, Chrystèle Rubod¹, Michel Cosson¹

Affiliation

¹ Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France.

PMID: 38725418
DOI: 10.1002/nau.25485

Abstract

Introduction: There is no guideline or clinical consensus concerning the mid-urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery.

Methods: We performed a systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis.

Results: Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I² = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I² = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73-1.40; p = 0.96 and I²-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I²-test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77-2.01; p = 0.37 and I²-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I²-test of 0% p = 0.47). BMI ≥ 30 kg/m², urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse.

Conclusion: Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy.

Keywords: childbirth; delivery; mid‐urethral sling; pregnancy; stress urinary incontinence; suburethral sling.

Publication types

Review