Investigation of risk factors of de novo urinary stress incontinence after cystocele repair: A retrospective cohort study

Hu, Pan; Li, Lei; Wei, Linna; Wang, Ying; Liu, Lubin

doi:10.1002/ijgo.14164

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…In order to get more evidence of relationship between levator avulsion and SUI, we started to collect data of patients suffered from levator avulsion who also performed TVM for cystocele repair. Previous data showed levator avulsion may cause de novo SUI after TVM, no matter unilateral avulsion or bilateral avulsion [27]. After we increasing sample size and more women suffered from bilateral avulsion were recruited, the results seemed different.…”

Section: Discussionmentioning

confidence: 84%

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair surgery

LIU

Wei

et al. 2023

Preprint

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Purpose To estimate whether levator ani injuries increase the risk of de novo urinary stress incontinence after cystocele repairing surgery. Methods A total of 1124 women who were underwent cystocele repaired surgeries were recruited and assessed for eligibility from January,1,2012 to April,30,2021. All data related to patients and surgeries was collected and followed-up, which included general conditions, clinical examination, ultrasound results and follow-up results. Data was compared according to the follow up results. The relative risk (RR) of de novo urinary stress incontinence (SUI) with levator avulsion was calculated. Results 336 women were involved eventually. They were divided into no complication group (n=249), de novo SUI group (n=68) and other complications group (n=19). It seemed elder or obese women were more likely to get poor results after TVM repair (p＜0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups(p=0.001). TVM can significantly change a prolapse to point Aa and Ba on POP-Q (p＜0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95%CI 1.39-4.87), and 2.58(95%CI 0.82 -8.15) for bilateral group. Conclusion Unilateral levator avulsion is a risk factor of de novo SUI after cystocele repair surgery.

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Section: Discussionmentioning

confidence: 84%

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair surgery

LIU

Wei

et al. 2023

Preprint

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“…Recent simulations performed using pelvic magnetic resonance imaging revealed that weakening of either the pubococcygeus or puborectalis muscles caused a shift in the urethral axis, representing a decrease in pelvic floor support, 32 which supports our conclusion. One study confirmed that LAM avulsion is a risk factor for de novo SUI after transvaginal mesh, and the relative risk ratio of de novo SUI with unilateral and bilateral LAM avulsion was 2.23 (95% CI: 1.35-3.68) and 3.12 (95% CI: 1.46-6.67), respectively, 33 warning us of the consequences of ignoring the LAM.…”

Section: Discussionmentioning

confidence: 96%

Analysis of the anatomical and biomechanical characteristics of the pelvic floor in cystocele

Song,

Wen,

Pan

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionStress urinary incontinence (SUI) occurs due to disruption of the pelvic floor anatomy; however, the complexity of the pelvic floor support structures and individual patient differences make it difficult to identify the weak points in the pelvic floor support that cause SUI to occur, develop, and recur. This study aimed to analyze the pelvic floor anatomy, structural features, and biomechanics of cystoceles to develop more effective treatment plans with individualized and precise healthcare.Material and methodsIn this observational case‐controlled study (clinical trial identifier BOJI201855L), 102 women with normal pelvic floor function and 273 patients diagnosed with cystocele degrees I–III were identified at Shanghai General Hospital from October 2016 to December 2019. We combined ultrasound and vaginal tactile imaging (VTI) to assess the anatomy and biomechanical functions of the anterior and posterior vaginal walls. Both examinations included relaxation and muscle tension tests.ResultsOf the 42 VTI parameters, 13 were associated with the degree of cystocele, six with an increase in the urethral rotation angle (pointing to the mobility of the urethra), and six with a decrease in the retrovesical angle (pointing to hypsokinesis and decrease in bladder position). According to these data, the strength of tissues, especially the muscles in both the anterior and posterior compartments, contributes to the stability of the pelvic floor structure. The strength of the levator ani muscle (LAM) is important for the degree of cystocele, mobility of the urethra, hypsokinesis, and decrease in bladder position.ConclusionsIn general, the biomechanical status of the pelvic floor in patients with cystocele is complex and involves various muscles, ligaments, tendons, and fascia. Of these, repair and exercise of the LAM have not received much attention in the treatment of patients with cystoceles, which may be an important risk factor for the high recurrence rate.

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“…Previous data showed levator avulsion may cause de novo SUI after TVM, no matter unilateral avulsion or bilateral avulsion. 19 After we increasing sample size and more women suffered from bilateral avulsion were recruited, the results seemed different. RR ratio showed only unilateral avulsion related to de novo SUI, which is in accordance with the results we presented before.…”

Section: Discussionmentioning

confidence: 98%

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair

Hu,

Liu,

Dai

et al. 2023

J of Obstet and Gynaecol

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IntroductionPatients without concurrent baseline stress urinary incontinence (SUI) can develop de novo SUI after transvaginal mesh surgery (TVM) for cystocele repair. Surgeons should be aware of de novo SUI risk factors after TVM.MethodsA total of 1124 women who were underwent TVM surgeries were recruited and assessed for eligibility from January 1, 2012 to April 30, 2021. All data related to patients and surgeries was collected, which included general conditions, clinical examination, surgery records, and follow‐up results. Patients were divided into three groups according to follow‐up results and data were compared with each group. The relative risk (RR) of de novo SUI with levator avulsion was also calculated.ResultsThree hundred thirty‐six patients were included in this study. They were divided into no complication group (n = 249), de novo SUI group (n = 68), and other complications group (n = 19). It seemed elder or obese women had a higher risk of de novo SUI after TVM (p < 0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups (p = 0.001). TVM can significantly change a prolapse to point Aa and Ba on POP‐Q quantification system (p < 0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95% confidence interval [CI] 1.39–4.87), and 2.58 (95%CI 0.82–8.15) for bilateral group.ConclusionUnilateral levator avulsion, instead of bilateral levator avulsion, is a risk factor of de novo SUI after cystocele repair surgery.

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Investigation of risk factors of de novo urinary stress incontinence after cystocele repair: A retrospective cohort study

Abstract: The contents of this page will be used as part of issue TOC only. It will not be published as part of main article.Levator avulsion is a risk factor for de novo urinary stress incontinence after transvaginal mesh surgery for cystocele repair.

Cited by 5 publications

References 3 publications

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair surgery

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair surgery

Analysis of the anatomical and biomechanical characteristics of the pelvic floor in cystocele

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair

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