Incidence And Risk Factors Of Stress Urinary Incontinence After Pelvic Organ Prolapse Repair

BackgroundPelvic floor dysfunction(PFD)is a series of disease with displacement or disfunction of pelvic organs caused by injury or degration of supporting structure,including pelvic organ prolapse(POP),fecal incontinence and stress urinary incontinence(SUI)and so on.The incidence of PFD is growing with the increasing population of old women.POP and SUI are often associated with each other because of similar pathogenesis,and more than half of POP patients have concomitant SUI,and it’s still controversial whether anti-incontinennce procedure should performed at the same time as POP surgery.As for continent POP women,up to 64.7%of them would develope postoperative SUI(POSUI)after POP surgery.In order to prevent POSUI and decrease the rate of secondary surgery for SUI,some have advocated for anti-incontinence procedure at the time of POP repair in women with risk factors of POSUI.But it is still a challenge for clinicians to screen the women which can benifit most from a concomitant anti-incontinence surgery.It is reported that many factors are associated with appearance of POSUI,including occult stress urinary invontinence(OSUI),age,diabetes,obesity and so on,but it is still difficult to predict the occurrence of POSUI.ObjectiveTo study the efficiency of conconmitant anti-continennce procedure in pelvic floor reconstruction surgery for POP women with SUI,and to determine the rate and specific risk factors for POSUI following POP repair in women without subjective SUI symptom,helping cinlicians and patients with preoperative evaluation and personalized treatment.MethodsData from Qilu hospital was retrieved to identify POP women with stage Ⅱ or above who had received POP repair between 2015-2018 with at least one-year follow-up,and 270 patients enrolled in this study and completed the telephone follow-up.The patiets was devided into two parts depending on whether had subjective SUI or not before POP surgery:108 POP patients with SUI symptom before surgery,and 162 POP patients without SUI symptom.For part one,according to whether concomitant anti-incontinence was performed at the same time with POP repair,108 POP patients with SUI symptom before surgery were devided into two groups:POP repair surgery group and combined surgery group.The incidence of SUI after surgery between two groups were compared to evaluate the efficiency of conconmitant anti-incontinennce procedure in POP surgery.Part two,depending on whether POSUI occuredor not after POP surgery,162 POP patients without SUI symptom before surgery were devided into two groups:postoperative SUI group(POSUI group)and no postoperative SUI group(control group).The basic clinical information,surgical methods and other related factors of two groups was compared,and statistical analysis was made by SPSS 24.0(P<0.05 was considered statistically significant)to screen the risk factors that related to POSUI.And Incontinence impact questionnaire-7-short form(IIQ-7)and International consultation on incontinence questionnaire-short form(ICI-Q-SF)were completed to assess the severity of the SUI symptom and its impact on life.ResultsPart 1,analysis of subjective SUI after surgery in POP patients with SUI1.The change of of subjective SUI after surgery:17.2%(16/93)patients in POP repair group declared absence of leaking symptom,compared 60%(9/15)in combined surgery group;41.9%(39/93)patients declared improvement in POP repair group,compared 33.3%(5/15)in combined surgery group;patients declared unchanged or aggravated account for 40.9%vs 6.7%.Rates were compared,showing a statistically significant difference between two groups(P<0.05).2.15 patients involved in combined surgery group,different anti-incontinence surgery with POP repair.8 patients carried out TVTO,and 75%(6/8)patients declared absence of leaking symptom,2 patients improved after surgery.The other 7 patients carried out urethroplasty,and 42.9%(3/7)patients declared absence of leaking symptom,2 patients improved after surgery,1 patient unchangedPart 2,analysis of POSUI in POP patients without SUI1.The incidence rate of POSUI:20.4%(33/163)POP patients without SUI declared leaking symptom after surgery,among whom 63.6%(21/33)patients were mild,36.4%(12/33)were moderate,according to the effect on life.2.Univariate analysis on risk factors related with POSUI2.1 Clinical characteristics:BMI of patients in POSUI group is larger than control group(25.71 vs 24.25,P<0.05),and the difference is statistically significant.And there is no statistical difference between two groups on age,rate of menopause,diabetes,high blood pressure,constipation,chronic cough,pregnancy,labor,history of macrosomia,POP-Q stage,degree of anterior wall prolapse,pelvic surgery,hormone replacement therapy(P>0.05).2.2 Surgery:vagina anterior wall repair is not related with POSUI(P>0.05);the rate of mesh usage in surgery in POSUI group is higher than control group(30.3%vs 14.0%,P<0.05)),and the difference is statistically significant.The incidence of POSUI in patients with traditional transvaginal repair surgery is 17.2%(23/134),compared with which,the incidence of POSUI in patients with laparoscopic abdominal wall suspension(mesh)is higher,but showed no statistical difference(37.5%vs 17.2%,P=0.085).And similar results is seen in patients with laparoscopic sacrumfixation(22.2%vs 17.2%,P=0.655).3.Multivariate Logistic analysis on risk factors related with POSUI:obesity was an independent risk factor for POSUI in POP patients without incontinence(P<0.05,OR 1.173,95%CI 1.025～1.343).The difference of mesh usage in surgery was not statistically significant in Logistic regression model for multivariate analysis(P =0.052,OR 1.354,95%CI 0.998～1.836),considering mesh usage in surgery tend to be a risk factor of POSUI in preoperative continent POP patients.Conclusion1.Concomitant anti-incontinence procedure in POP repair surgery can significanly reduce the incidence of SUI in POP patients with SUI before surgery2.The incidence of POSUI in POP patients without subjective SUI before surgery was low,and most of them declared little impact on their life,so concomitant anti-incontinence procedure is not suggested at the same time with POP repair.3.Obesity was an independent risk factor for POSUI in POP patients without incontinence before surgery.There is a tendency towards a higher incidence of POSUI in preoperative continent POP patiences with usage of mesh in surgery.