title: Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis.
abstract: Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) are associated with physical and psychological morbidity, and large societal costs. The long-term effects of delivery modes on each kind of incontinence remain uncertain.
  
  
  
  To investigate the long-term impact of delivery mode on SUI and UUI.
  
  
  
  We searched Medline, Scopus, CINAHL, and relevant major conference abstracts up to October 31, 2014, including any observational study with adjusted analyses or any randomized trial addressing the association between delivery mode and SUI or UUI ≥1 yr after delivery. Two reviewers extracted data, including incidence/prevalence of SUI and UUI by delivery modes, and assessed risk of bias.
  
  
  
  Pooled estimates from 15 eligible studies demonstrated an increased risk of SUI after vaginal delivery versus cesarean section (adjusted odds ratio [aOR]: 1.85; 95% confidence interval [CI], 1.56-2.19; I(2)=57%; risk difference: 8.2%). Metaregression demonstrated a larger effect of vaginal delivery among younger women (p=0.005). Four studies suggested no difference in the risk of SUI between spontaneous vaginal and instrumental delivery (aOR: 1.11; 95% CI, 0.84-1.45; I(2)=50%). Eight studies suggested an elevated risk of UUI after vaginal delivery versus cesarean section (aOR: 1.30; 95% CI, 1.02-1.65; I(2)=37%; risk difference: 2.6%).
  
  
  
  Compared with cesarean section, vaginal delivery is associated with an almost twofold increase in the risk of long-term SUI, with an absolute increase of 8%, and an effect that is largest in younger women. There is also an increased risk of UUI, with an absolute increase of approximately 3%.
  
  
  
  In this systematic review we looked for the long-term effects of childbirth on urinary leakage. We found that vaginal delivery is associated with an almost twofold increase in the risk of developing leakage with exertion, compared with cesarean section, with a smaller effect on leakage in association with urgency.
authors.affiliation: Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland; Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
authors.forename: Riikka M
authors.initials: RM
authors.lastname: Tähtinen
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Urogynecology, Imperial College London, London, UK.
authors.forename: Rufus
authors.initials: R
authors.lastname: Cartwright
authors.affiliation: Department of Urology, North Shore-LIJ Lenox Hill Hospital, New York, NY, USA; Institute for Bladder and Prostate Research, New York, NY, USA.
authors.forename: Johnson F
authors.initials: JF
authors.lastname: Tsui
authors.affiliation: Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Riikka L
authors.initials: RL
authors.lastname: Aaltonen
authors.affiliation: Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: Department of Clinical Practice Guidelines, National Center for Health Technology Excellence, México, Mexico.
authors.forename: Jovita L
authors.initials: JL
authors.lastname: Cárdenas
authors.affiliation: Department of Anesthesiology, Botucatu Medical School, São Paulo State University, São Paulo, Brazil.
authors.forename: Regina
authors.initials: R
authors.lastname: El Dib
authors.affiliation: Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Kirsi M
authors.initials: KM
authors.lastname: Joronen
authors.affiliation: Department of Obstetrics and Gynecology, King Saud bin Abdulaziz University for Health Sciences, and King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
authors.forename: Sumayyah
authors.initials: S
authors.lastname: Al Juaid
authors.affiliation: Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors.forename: Sabreen
authors.initials: S
authors.lastname: Kalantan
authors.affiliation: Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Kochana
authors.affiliation: Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Kopec
authors.affiliation: Pharmaceutical Science Master Courde, University of Sorocaba, São Paulo, Brazil; School of Pharmaceutical Sciences, Department of Drugs and Medications, Paulista State University, São Paulo, Brazil.
authors.forename: Luciane C
authors.initials: LC
authors.lastname: Lopes
authors.affiliation: Department of Obstetrics and Gynecology, St. Mary's Hospital, London, UK.
authors.forename: Enaya
authors.initials: E
authors.lastname: Mirza
authors.affiliation: Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Sanna M
authors.initials: SM
authors.lastname: Oksjoki
authors.affiliation: Department of Urology, Päijät-Häme Central Hospital, Lahti, Finland.
authors.forename: Jori S
authors.initials: JS
authors.lastname: Pesonen
authors.affiliation: Department of Obstetrics and Gynecology, South Karelia Central Hospital, Lappeenranta, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Valpas
authors.affiliation: Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Canada; Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.affiliation: Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: kari.tikkinen@gmail.com.
authors.forename: Kari A O
authors.initials: KAO
authors.lastname: Tikkinen
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D036801:Parturition; D012307:Risk Factors; D013997:Time Factors; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*; D053202:Urinary Incontinence, Urge / Q000453:epidemiology*; D014621:Vagina
keywords: Cesarean section; Forceps; Instrumental delivery; Stress urinary incontinence; Systematic review; Urgency urinary incontinence; Vacuum; Vaginal delivery