Pregnancy and delivery after mid-urethral sling procedures for stress urinary incontinence: case reports and a review of literature.
In this article, the effects of pregnancy and delivery on the development of stress urinary incontinence are described with special emphasis on the obstetrical management in women who wish to become pregnant or are pregnant after a preceding mid-urethral sling procedure. Three case histories and a review of literature are presented. Pregnancy after a preceding incontinence operation is rare and makes it quite difficult to formulate guidelines about delivery when a pregnancy occurs. The best advice is to postpone incontinence surgery until after the last pregnancy. There is evidence that an elective caesarean delivery protects against stress urinary incontinence in case of pregnancy after bladder neck suspension. For mid-urethral sling procedures, this evidence is not available. The presented case reports do not clearly demonstrate that caesarean delivery is necessary in case of pregnancy and delivery after a mid-urethral sling procedure. Furthermore, a second mid-urethral sling operation is a minor procedure compared to a caesarean section, and there is evidence that a second mid-urethral sling operation has the same success rate as the first procedure.
Groenen
Rian
R
Department of Gynecology and Obstetrics, St. Elisabeth Hospital, P.O. Box 90151, 5000 LC Tilburg, The Netherlands. riangroenen@hotmail.com
Vos
M Caroline
MC
Willekes
Christine
C
Vervest
Harry A M
HA
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D019919:Prosthesis Implantation / Q000295:instrumentation*; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*