Pregnancy and delivery after mid-urethral sling operation
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ORIGINAL ARTICLE
Pregnancy and delivery after mid-urethral sling operation Sari A. Tulokas 1
&
Päivi Rahkola-Soisalo 1 & Mika Gissler 2,3 & Tomi S. Mikkola 1,4 & Maarit J. Mentula 1
Received: 18 June 2020 / Accepted: 13 August 2020 # The Author(s) 2020
Abstract Introduction and hypotheses There is no consensus regarding pregnancy after mid-urethral sling (MUS) operation, and some clinicians recommend postponing the MUS operation if a woman considers further pregnancies or routinely suggest cesarean section as the delivery method after MUS operations. Our primary aim was to assess the risk for stress urinary incontinence (SUI) re-procedure after delivery in women with a MUS operation prior to pregnancy. We also analyzed SUI re-visits and MUS-related complications during pregnancy and postpartum. Methods We conducted a register-based case-control study of women with a MUS operation in Finland during 1996–2016. We identified 94 cases with a subsequent pregnancy and 330 controls without subsequent pregnancies matched by age, operation type and year. Results The median follow-up time was 10.7 years (IQR 7.1–13.7). The number of SUI re-procedures did not differ between the cases (n = 3, 3.2%) and controls (n = 17, 5.2%; OR 0.6, 95% CI 0.2–2.1). There was no significant difference in re-visits for stress or mixed urinary incontinence between the cases (n = 23, 24.5%) and controls (n = 86, 26.1%; OR 0.9, 95% CI 0.5–1.6), but 35% of the re-visits in the case group occurred already before the delivery after MUS. The rate of vaginal delivery was lower after MUS operation (57%) than in deliveries before MUS (91%, P < 0.001). Conclusions Pregnancy after MUS did not increase the odds for SUI re-procedure or re-visit. Considering on our results, future pregnancy does not need to be viewed as an absolute contraindication for MUS operation. Keywords Mesh tape . Mid-urethral sling . Pregnancy . Stress urinary incontinence . TOT . TVT . TVT-O
Introduction Stress urinary incontinence (SUI) is a common disorder in women. Approximately 10–14% of women will have an Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04497-w) contains supplementary material, which is available to authorized users. * Sari A. Tulokas [email protected] 1
Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, PO Box 140, FI-00029 Helsinki, HUS, Finland
2
Finnish Institute for Health and Welfare (THL), 00300 Helsinki, Finland
3
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, SE-171 77 Stockholm, Sweden
4
Folkhälsan Research Center, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
operation for SUI during their lifetime [1, 2], and the midurethral sling (MUS) is considered the gold standard surgical treatment for SUI. Women are commonly advised to postpone surgical treatment for SUI until childbearing has been completed [3] because of the fear of SUI relapse or complications during pregnancy or delivery [3]. It
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