title: Does visceral peritoneal closure affect post-cesarean urinary symptoms? A randomized clinical trial.
abstract: OBJECTIVE
  We hypothesized that upward bladder traction by visceral peritoneal closure during cesarean sections may have an impact on postpartum urinary complaints.
  
  
  METHODS
  Based on a 90% power of the study and a 95% confidence interval, a sample size of 114 patients in each arm was needed to detect a 15% difference between both groups regarding postpartum urinary incontinence. To account for follow-up losses, we prospectively randomized 620 term primigravidas undergoing non-emergency cesareans into two groups (310 each): group 1, visceral peritoneal closure; group 2, non-closure. We compared perineal ultrasound findings 30 min before and 48 h after surgery. The UDI-6 questionnaire was used to assess urinary complaints.
  
  
  RESULTS
  Group 1 showed significant widening of the posterior urethrovesical angle and alpha angle, more urethral descent 48 h postpartum and higher incidence of frequency, urge and stress incontinence 8 weeks postpartum. Symptoms disappeared almost completely after 6 months.
  
  
  CONCLUSIONS
  Compared to visceral peritoneal non-closure, cesarean with visceral closure is associated with significant postpartum frequency of urination and/or incontinence that disappear without treatment almost completely within 6 months.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University, Assiut, Egypt. Ahmed.Shahin@web.de
authors.forename: Ahmed Y
authors.initials: AY
authors.lastname: Shahin
authors.forename: Diaa A
authors.initials: DA
authors.lastname: Hameed
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D010537:Peritoneum / Q000000981:diagnostic imaging / Q000601:surgery*; D049590:Postpartum Period; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*; D014781:Viscera / Q000601:surgery*