Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth.

OBJECTIVE: To estimate differences in pelvic floor disorders by mode of delivery. METHODS: We recruited 1,011 women for a longitudinal cohort study 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth. At enrollment, stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders. RESULTS: Compared with cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.5) and prolapse to or beyond the hymen (OR 5.6, 95% CI 2.2-14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5, 95% CI 2.7-20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse. Among women delivering exclusively by cesarean, neither active labor nor complete cervical dilation increased the odds for any pelvic floor disorder considered, although the study had less than 80% power to detect a doubling of the odds with these exposures. CONCLUSION: Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth. LEVEL OF EVIDENCE: II.

Outcomes of Retropubic Synthetic Midurethral Gynecare TVT Slings When Performed by Urogynecologists, Urologists, and General Gynecologists in a Private Community Hospital.

OBJECTIVES: : To compare perioperative outcomes of a retropubic synthetic midurethral Gynecare TVT slings (Gynecare Worldwide, division of Ethicon Inc, NJ) performed by urogynecologists, urologists, and general gynecologists. METHODS: : This is a retrospective, cohort study of retropubic synthetic midurethral Gynecare TVT sling outcomes performed between 2001 and 2007 at a single institution. Other synthetic and nonsynthetic slings, or slings performed with concurrent surgeries were excluded. The primary outcomes were mean sling operating room (OR) time in minutes (min) and estimated blood loss in milliliters (mL). All variables were stratified by the surgeon's specialty: urogynecology (URO-GYN), urology (URO), and general gynecology (GYN). RESULTS: : Of 279 Gynecare TVT sling procedures, 126 were performed by URO-GYN, 30 by URO, and 123 by GYN. Mean sling OR time was 38.8 ± 8.5 minutes for URO-GYN, 42.6 ± 11.2 minutes for URO, and 39.8 ± 14.3 minutes for GYN, P = 0.30. Estimated blood loss was 56.6 ± 68.3 mL for URO-GYN, 69.7 ± 82.6 mL for URO, and 68.8 ± 73.4 mL for GYN, P = 0.37. The intraoperative complications (bladder, urethral perforations, and hemorrhage) were similar among the specialties. In the postoperative period, there was no difference in subsequent need for urethrolysis (cutting or removal of the sling), return to OR, and readmission to the hospital after the procedure among all 3 specialties. CONCLUSIONS: : All 3 specialties (urogynecologist, urologists, and general gynecologists) had similar major perioperative outcomes in performing retropubic synthetic midurethral Gynecare TVT slings.

Anatomic outcomes of vaginal mesh procedure (Prolift) compared with uterosacral ligament suspension and abdominal sacrocolpopexy for pelvic organ prolapse: a Fellows' Pelvic Research Network study.

OBJECTIVE: The objective of the study was to compare apical support anatomic outcomes following vaginal mesh procedure (VMP) (Prolift) to uterosacral ligament suspension (USLS) and abdominal sacrocolpopexy (ASC). STUDY DESIGN: This multicenter, retrospective chart review compared apical anatomic success (stage 0 or 1 based on point C or D of the Pelvic Organ Prolapse Quantification), level of vaginal apex (point C or D) 3-6 months after prolapse repair at 10 US centers between 2004 and 2007. RESULTS: VMP, USLS, and ASC were performed for 206, 231, and 305 subjects respectively. There was no difference in apical success after VMP (98.8%) compared with USLS (99.1%) or ASC (99.3%) (both P = 1.00) 3-6 months after surgery. The average elevation of the vaginal apex was lower after VMP (-6.9 cm) than USLS (-8.05 cm) and ASC (-8.5 cm) (both P < .001) CONCLUSION: Patients undergoing VMP have similar apical success compared with USLS and ASC despite lower vaginal apex 3-6 month after surgery.