Incidence and characteristics of <em>de novo</em> stress urinary incontinence after pelvic organ prolapse vaginal repair
BACKGROUND Some patients who undergo pelvic floor reconstruction for pelvic organ prolapse (POP) may experience a de novo stress urinary incontinence (SUI) postoperatively. We aimed to investigate the incidence and characteristics of de novo SUI in patients who underwent pelvic floor reconstruction at the national referral hospital in Indonesia.
METHODS This cross-sectional study evaluated 108 patients who underwent pelvic floor reconstruction due to POP between January 2016 and December 2017. Per the inclusion criteria, 75 women were enrolled using a consecutive sampling. The incidence of de novo SUI was determined 6–12 months postoperatively using the Indonesian version of the questionnaire for urinary incontinence diagnosis and objectively using the cough stress test during gynecologic examination after a negative preoperative prolapse reduction stress test.
RESULTS The average age, parity, body mass index, and years since menopause onset were 56.17 (4.67) years, 3.17 (1.07), 28.58 (5.18) kg/m2, and 12.8 (7.0) years, respectively. De novo SUI was seen in 8.0% (6 of 75) patients at 6–7 months postoperatively, with 3 (50.0%) had severe POP and 3 (50.0%) had a mild POP. Most of these patients (4 of 6, 66.7%) had undergone procedures other than colpocleisis for POP reconstruction.
CONCLUSIONS The incidence of de novo SUI after gynecologic surgery for POP at a national referral hospital in Indonesia is 8%. Most patients were aged <60 years, had a parity of <4, were nonobese, were menopausal, and had diabetes.
Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. https://doi.org/10.1038/nrdp.2017.97
Sumardi R, Mochtar CA, Junizaf, Santoso BI, Setiati S, Nuhonni SA, et al. Prevalence of urinary incontinence, risk factors and its impact: multivariate analysis from Indonesian nationwide survey. Acta Med Indones. 2014;46(3):175-82.
Wang SY, Cao TT, Wang RZ, Yang X, Sun XL, Wang JL. Incidence and risk factors of de novo stress urinary incontinence after pelvic floor reconstruction: a nested case-control study. 2017. Chin Med J. 2017;130(6):678-83. https://doi.org/10.4103/0366-6999.201592
Alas AN, Chinthakanan O, Espaillat L, Plowright L, Davila GW, Aguilar VC. De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence. Int Urogynecol J. 2017;28(4):583-90. https://doi.org/10.1007/s00192-016-3149-7
Fakhrizal E, Priyatini T, Santoso BI, Junizaf J, Moegni F, Djusad S, et al. Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women. Med J Indones. 2016;25(3):163-70. https://doi.org/10.13181/mji.v25i3.1407
Putra IGM, Megadhana IW, Suwiyoga K, Junizaf, Santoso BI. Prevalence of urinary incontinence in women with pelvic organ prolapse at Sanglah hospital Denpasar, Bali-Indonesia. Bali Med J. 2016;5(1):125-8. https://doi.org/10.15562/bmj.v5i1.263
Developed by the Joint Writing Group of the American Urogynecologic Society and the Internasional Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2020;26(3):173-201. https://doi.org/10.1097/SPV.0000000000000846
Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic organ prolapse quantification system (pop-q) - a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75-81.
Borstad E, Rud T. The risk of developing urinary stress-incontinence after vagina repair in continent woman. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand. 1989;68(6):545-9. https://doi.org/10.1111/j.1600-0412.1989.tb07836.x
Colombo M, Maggioni A, Zanetta G, Vignali M, Milani R. Prevention of postoperative urinary stress incontinence after surgery for genitourinary prolapse. Obstet Gynecol. 1996;87(2):266-71. https://doi.org/10.1016/0029-7844(95)00378-9
Aungst MJ, Friedman EB, von Pechmann WS, Horbach NS, Welgoss JA. De novo stress incontinence and pelvic muscle symptoms after transvaginal mesh repair. Am J Obstet Gynecol. 2009;201(1):73.e1-7. https://doi.org/10.1016/j.ajog.2009.02.028
Kasturi S, Diaz SI, McDermott CD, Woodman PJ, Bump RC, Terry CL, et al. De novo stress urinary incontinence after negative prolapse reduction stress testing for total vaginal mesh procedures: incidence and risk factors. Am J Obstet Gynecol. 2011;205(5);487.e1-4. https://doi.org/10.1016/j.ajog.2011.07.006
Al-Mandeel H, Ross S, Robert M, Milne J. Incidence of stress urinary incontinence following vaginal repair of pelvic organ prolapse in objectively continent women. Neurourol Urodyn. 2011;30(3):390-4. https://doi.org/10.1002/nau.20947
Hafidh BA, Chou Q, Khalil MM, Al-Mandeel H. De novo stress urine incontinence after vaginal repair for pelvic organ prolapse: one-year follow-up. Eur J Obstet Gynecol Reprod Biol. 2013;168(2):227-30. https://doi.org/10.1016/j.ejogrb.2012.12.029
Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopy sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J. 2013:24(3);485-91. https://doi.org/10.1007/s00192-012-1888-7
Lo TS, Bt Karim N, Nawawi EA, Wu PY, Nusee Z. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogynecol J. 2015;26(9):1313-9. https://doi.org/10.1007/s00192-015-2685-x
Kanasaki H, Oride A, Mitsuo T, Miyazaki K. Occurrence of pre- and postoperative stress urinary incontinence in 105 patients who underwent tension-free vaginal mesh surgery for pelvic organ prolapse: a retrospective study. ISRN Obstet Gynecol. 2014;2014:643495. https://doi.org/10.1155/2014/643495
Wang J, Chu L, Guo Y, Li L, Gao T, Li H, et al. Urinary incontinence after surgical repair in patients with pelvic organ prolapse. Biomed Res. 2014;25(4):588-91.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5-26. https://doi.org/10.1007/s00192-009-0976-9
Jundt K, Wagner S, von Bodungen V, Friese K, Peschers UM. Occult incontinence in women with pelvic organ prolapse - does it matter? Eur J Med Res. 2010;15(3):112-6. https://doi.org/10.1186/2047-783X-15-3-112
Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358-67. https://doi.org/10.1056/NEJMoa1111967
Bergman A, Koonings PP, Ballard CA. Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapse. Am J Obstet Gynecol. 1988;158(5):1171-5. https://doi.org/10.1016/0002-9378(88)90248-7
Ellström Engh AM, Ekeryd A, Magnusson A, Olsson I, Otterlind L, Tobiasson G. Can de novo stress incontinence after anterior wall repair be predicted? Acta Obstet Gynecol Scand. 2011;90(5):488-93. https://doi.org/10.1111/j.1600-0412.2011.01087.x
Jelovsek JE, Chagin K, Brubaker L, Rogers RG, Richter AE, Arya L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(201):279-87. https://doi.org/10.1097/AOG.0000000000000094
Copyright (c) 2021 Suskhan Djusad, Ihya Ridlo Nizomy, Surahman Hakim, Tyas Priyatini, Fernandi Moegni, Alfa Putri Meutia, Budi Iman Santoso
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.