Postpartum urinary incontinence of nulliparous women: A prospective cohort study

Postpartum urinary incontinence affects women's quality of life. It is associated with different risk factors during pregnancy and childbirth. We evaluated the persistence of postpartum urinary incontinence and associated risk factors among recently delivered nulliparous women with incontinence during pregnancy. This was a prospective cohort study, which followed up all nulliparous women recruited antenatally from 2012 to 2014 in Al-Ain Hospital, Al-Ain, United Arab Emirates, who developed urinary incontinence for the first time during pregnancy. Three months after giving birth they were interviewed face-to-face, using a structured and pre-tested questionnaire, and divided into 2 groups: those who had urinary incontinence and those without it. Risk factors were compared between the 2 groups. Of the 101 participants interviewed, postpartum urinary incontinence continued in 14 (13.7%) while 87 (86.3%) recovered from it. The comparative analysis did not show any statistically significant difference between the 2 groups for sociodemographic risk factors nor for antenatal risk factors. Childbirth-related risk factors were also not statistically significant. Recovery from incontinence during pregnancy in nulliparous women was over 85% as postpartum urinary incontinence affected only a small proportion at 3 months following delivery. Expectant management is advised instead of invasive interventions in these patients.

Post-operative tension adjustment-A simple technical modification in mid-urethral slings (MUS) for stress urinary incontinence (SUI)

INTRODUCTION

Mid-urethral sling (MUS) surgeries have revolutionized the management of stress urinary incontinence (SUI). However, MUS is a delicate balance of tension on the mid urethral segment with a 12 % risk of failure to achieve complete continence; and up-to 20 % chance of post-operative voiding dysfunction. We propose a simple technical modification in which the long ends of the tape at suprapubic or groin area are not cut immediately and are covered with a sterile dressing. After 48-72 h post-surgery the patient is checked for continence and voiding difficulties. Following this an ultrasonographic assessment of post-void residual urine is performed. Keeping in mind these 3 criteria the tape is adjusted. After complete subjective as well as objective satisfaction the long ends of tape are cut.

MATERIAL AND METHODS

This is a retrospective analysis of women who underwent MUS surgery for the management of SUI, with our simple technical modification of tape adjustment in the postoperative period. A total of 17 patients operated by single surgeon in one year were included.

RESULTS

Our results show that 58.8 % of our patients who underwent MUS procedures required post-operative tape adjustment. The number was significantly higher in the MUS - Retropubic group (85.7 %) as compared to the MUS - Obturator group (40 %). Three patients in the MUS - Retropubic group required a second time tape adjustment. Following tape adjustment all patients had complete continence (subjective and objective), with no voiding dysfunction.

CONCLUSION

The incidence of postoperative voiding dysfunction is significant following MUS surgery for SUI. A simple technical modification of delaying the cutting of the tape for two to three days gives the opportunity for perfect tension adjustment.