More Long Term Stress Incontinence With Vaginal Delivery vs C-Section

MedicalResearch.com Interview with:

Kari Aarne Olavi Tikkinen, M.D PHD Urology resident and clinical epidemiologist Department of Urology Helsinki University Central Hospital and University of Helsinki Helsinki, Finland

Dr. Kari Tikkinen

Kari Aarne Olavi Tikkinen, M.D PHD
Adjunct Professor
Department of Urology
Helsinki University Central Hospital and University of Helsinki
Helsinki, Finland

Medical Research: What is the background for this study?

Dr. Tikkinen: ?Stress and urgency incontinence are the two most frequent and the most bothersome urinary symptoms among women. It has been estimated that about twelve percent of women report significant bother from stress incontinence and eight percent from urgency incontinence. Both stress urinary incontinence and urgency urinary incontinence are associated with substantial physical and psychological morbidity, and large societal costs.

An extensive body of evidence suggests that delivering vaginally versus caesarean section increases rates of post-partum stress urinary incontinence. The magnitude of long term effects of different delivery modes on stress and urgency urinary incontinence remain, however, uncertain. ?

Medical Research: What are the main findings?

Dr. Tikkinen: ?In the pooled analyses, we found an almost two-fold increase in the risk of developing long-term stress urinary incontinence, an absolute increase of approximately 8%, a gradient that is larger in younger and smaller in older women, and a small increased risk of urgency urinary incontinence, an absolute increase of approximately 3%, in vaginal delivery versus caesarean section.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tikkinen: ?The results of our? meta-analysis provides important information about the causes of urgency and stress urinary incontinence in women, quantify one important aspect of caesarean section, and help women and their physicians make decisions regarding mode of delivery

?P?otentially increasing use of cesarean section may have beneficial public health consequences from the perspective of pelvic floor health, including decreased need for stress urinary incontinence and pelvic organ prolapse surgery. While we have quantified one benefit of planned cesarean, women and their caregivers must, however, consider other consequences. Planned cesarean section confers an increased risk of neonatal intensive care admission for the baby, and a substantially longer hospital stay for the mother. A prior cesarean also carries risks in future pregnancies, including an increased risk of uterine rupture, and abnormal placentation?.

In general the medicalization of pregnancy associated with planned cesarean may also be undesirable from both individual and societal perspectives.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tikkinen: ? This meta-analysis is almost solely based on observational data. More pragmatic, well designed and well powered randomized trials are more than welcome. Studies to enhance our understanding how to better identify before delivery those women at high risk of these problems would be very useful, too.

Citation:

Eur Urol. 2016 Feb 10. pii: S0302-2838(16)00156-1. doi: 10.1016/j.eururo.2016.01.037. [Epub ahead of print]

Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis.

Tähtinen RM1, Cartwright R2, Tsui JF3, Aaltonen RL4, Aoki Y5, Cárdenas JL6, El Dib R7, Joronen KM4, Al Juaid S8, Kalantan S9, Kochana M10, Kopec M10,Lopes LC11, Mirza E12, Oksjoki SM4, Pesonen JS13, Valpas A14, Wang L15, Zhang Y16, Heels-Ansdell D16, Guyatt GH17, Tikkinen KA18.

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Dr. Kari Aarne Olavi Tikkinen (2016). More Long Term Stress Incontinence With Vaginal Delivery vs C-Section