This study aimed to establish the prevalence and effect of urinary incontinence on quality of life during pregnancy and after parturition. A prospective cohort of primigravidae was recruited. The Kings Health Questionnaire (KHQ) was self-administered antenatally (34 weeks to term) and postnatally (3 months after delivery). Four hundred ninety-two primigravidae were recruited. The prevalence of urinary incontinence was reported as: pre-pregnancy 3.5% (17/492), antenatal 35.6% (175/492), 3-5 days postpartum 13.7% (51/370) and 3 months postnatal 13.0% (47/362). Most women with urinary incontinence experienced an impact on quality of life antenatally (54.3%) and postnatally (71.1%), although those experiencing an impact usually reported it as 'a little' (75.8 and 87.5%). There was a higher prevalence of urinary incontinence after forceps delivery ( p<0.05) but not of greater impairment in quality of life ( p>0.05). Personal and general health deteriorated postnatally ( p<0.05). During pregnancy most women with urinary incontinence experience minimal impact on quality of life. Postnatally, other causes of morbidity may contribute to worsening of general and personal health.

IMPORTANCE There is concern about outcomes of midurethral mesh sling insertion for women with stress urinary incontinence. However, there is little evidence on long-term outcomes. OBJECTIVE To examine long-term mesh removal and reoperation rates in women who had a midurethral mesh sling insertion for stress urinary incontinence. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study included 95 057 women aged 18 years or older who had a first-ever midurethral mesh sling insertion for stress urinary incontinence in the

Headline This is a longitudinal study of a cohort of primigravidae recruited between 1985 and 1987 and followed up 7 and 15 years later. Pelvic floor neurophysiology was performed and questionnaires were administered to determine the natural history of stress incontinence and to establish whether pelvic floor denervation after the first delivery is associated with symptoms of stress urinary incontinence in the future. Objectives To study the natural history of stress urinary incontinence arising during the first pregnancy, to determine whether postnatal pelvic floor denervation progresses with time and whether it predisposes to stress urinary incontinence in the future. Design Prospective longitudinal cohort study.Setting Tertiary referral urogynaecology unit.Sample Cohort of 96 primigravidae studied prospectively between 1985 and 1987 and followed up 7 years (n ¼ 76) and 15 years (n ¼ 55) later. Methods Urinary incontinence symptoms were recorded and pelvic floor neurophysiology was performed antenatally and postnatally between 1985 and 1987. Repeat neurophysiological tests and questionnaires were completed by those relocated 7 and 15 years later. Main outcome measure Symptoms of stress urinary incontinence.Secondary outcomes Symptoms of urge urinary incontinence and anal incontinence; motor unit potential duration and pudendal nerve terminal latency; vaginal squeeze pressure measured by perineometry. Results Prevalence of stress incontinence was highest during pregnancy and had increased seven years after the first postnatal period ( P ¼ 0.0129). Two-thirds of women with antenatal stress incontinence had stress incontinence 15 years later. One-third of women with stress incontinence at any time appear to undergo resolution of symptoms. Motor unit potential duration increased at seven years ( P ¼ 0.036). Vaginal squeeze pressure improved during the same period ( P ¼ 0.0007). Conclusions When stress urinary incontinence arises during the first pregnancy, the risk of stress incontinence occurring 15 years later is doubled. Although pelvic floor reinnervation progressed after the postnatal period, the absence of an adequate marker for pelvic floor denervation makes it of uncertain clinical significance.

Introduction and hypothesisThere is evidence that in nonsurgical populations, pelvic floor muscle training (PFMT) and lifestyle advice improves symptoms and stage of pelvic organ prolapse (POP). Some women, however, require surgery, after which de novo symptoms can develop or additional surgery is required due to recurrence. Robust evidence is required as to the benefit of perioperative PFMT in the postsurgery reduction of symptoms and POP recurrence. The aim of this study was to assess the feasibility of and collect pilot data to inform sample size (SS) calculation for a multicentre randomised controlled trial (RCT) of perioperative PFMT following surgical intervention for POP.MethodsFifty-seven participants were recruited and randomised to a treatment group (one pre and six postoperative PFMT sessions) or a control group (usual care). The primary outcome measure was the Pelvic Organ Prolapse Symptom Score (POP-SS) at 12 months; secondary outcome measures included measurement of prolapse, the pelvic floor and questionnaires relating to urinary and bowel incontinence. All outcomes were measured at 0, 6 and 12 months.ResultsInformation on recruitment, retention and appropriateness of outcome measures for a definitive trial was gathered, and data enabled us to undertake an SS calculation. When compared with the control group (n = 29), benefits to the intervention group (n = 28) were observed in terms of fewer prolapse symptoms at 12 months [mean difference 3.94; 95 % confidence interval (CI) 1.35–6.75; t = 3.24, p = 0.006]; however, these results must be viewed with caution due to possible selection bias.ConclusionWith modifications to design identified in this pilot study, a multicentre RCT is feasible.Electronic supplementary materialThe online version of this article (doi:10.1007/s00192-013-2301-x) contains supplementary material, which is available to authorized users.

CS provides incomplete or poorly sustained pelvic floor protection by middle age. Obese women were at highest risk and had the most severe symptoms.