GLASGOW—Women who have undergone surgical treatment of stress urinary incontinence (SUI) are at increased risk of requiring another operation if they had two or more vaginal deliveries, a study found.
The use of synthetic slings—tension-free vaginal tape (TVT) and trans-obturator tape (TOT)—reduced the risk.
From a cohort of 1,132 women who underwent SUI surgery from January 1988 to June 2007, Patrick Dällenbach, MD, and colleagues at Geneva University Hospitals in Switzerland identified 35 women who required a reoperation for SUI recurrence following the first surgery (cases) and compared them with 89 women randomly selected from the same cohort who did not require a second SUI surgery (controls).
The cumulative incidence of SUI reoperation was 3.1%. Among the cases, the mean interval between operations was 4.1 years (range 0.2 to 17.4 years). The control group had a mean follow-up of 10.9 years (range 1.7 to 21 years). A history of two or more vaginal deliveries was associated with a 3.5 times increased risk of reoperation, after adjusting for multiple variables, according to a poster presentation at the International Continence Society annual meeting. Age and body mass index did not affect the likelihood of reoperation. TVT and TOT surgeries decreased the risk of a reoperation by 88% compared to colposuspension.
“Risk factors and protective factors described in this study might help choose the optimal surgical technique,” the researchers stated.
A history of pelvic organ prolapse (POP) repair remained associated with an increased risk of reoperation in multivariable as well as univariable analysis. Although this association was not statistically significant, POP repair probably is a risk factor for reoperation, Dr. Dällenbach told Renal & Urology News. “The absence of statistical significance was probably due to a lack of power of the study,” he noted.