title: Is de novo stress incontinence after sacrocolpopexy related to anatomical changes and surgical approach?
abstract: OBJECTIVE
  The objective was to investigate the relationship between new onset postoperative stress urinary incontinence (SUI) after sacrocolpopexy (SCP) and anatomical change/surgical approach.
  
  
  METHODS
  We analyzed a retrospective cohort of patients with negative preoperative testing for SUI who underwent SCP from 2005 to 2012. Our primary outcome was new onset postoperative SUI. Logistic regression was used to examine the relationship among anatomical change, defined as ΔAa, ΔBa, ΔC, and ΔTVL, and surgical approach, categorized as abdominal (ASCP) for open cases and minimally invasive (MISCP) for laparoscopic and robot-assisted cases, and postoperative SUI.
  
  
  RESULTS
  Of 795 cases, 33 ASCP (43%) and 44 MISCP (57%) met the inclusion criteria for analysis. New onset SUI was demonstrated by 15 patients (45%) of the ASCP group and 7 patients (15%) of the MISCP group (p = 0.005). New onset SUI was significantly associated with route of SCP and ΔAa (p = 0.006 and p = 0.033 respectively). Controlling for ΔAa, the odds of new onset SUI were 4.4 times higher in the ASCP group compared with the MISCP group (OR 4.37, 95% CI 1.42, 13.48). Controlling for route of SCP, the odds of new onset SUI were 2.2 times higher with moderate ΔAa compared with low ΔAa (OR 2.16 95% CI 1.07, 4.38). The odds of new onset SUI was 4.7 times higher in those with high ΔAa than in those with low ΔAa (OR 4.67 95% CI 1.14, 19.22). ΔBa, ΔC, and ΔTVL were not associated with new onset SUI.
  
  
  CONCLUSIONS
  Greater reduction in point Aa and abdominal surgical route are risk factors for new onset postoperative SUI after SCP.
authors.affiliation: Division Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Sciences Center, 920 S. L. Young, 2430, Oklahoma City, OK, 73104, USA, edgar.leclaire@gmail.com.
authors.forename: Edgar L
authors.initials: EL
authors.lastname: LeClaire
authors.forename: Marium S
authors.initials: MS
authors.lastname: Mukati
authors.forename: Dianna
authors.initials: D
authors.lastname: Juarez
authors.forename: Dena
authors.initials: D
authors.lastname: White
authors.forename: Lieschen H
authors.initials: LH
authors.lastname: Quiroz
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009825:Oklahoma / Q000453:epidemiology; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000209:etiology*