Research Article
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The effect of vaginal delivery on stress urinary incontinence and bladder neck mobility: Transperineal ultrasound evaluation.

Year 2020, Volume: 17 Issue: 2, 349 - 353, 25.06.2020
https://doi.org/10.38136/jgon.670949

Abstract

ÖZET
GİRİŞ: Üriner inkontinans; her yaşta görülebilen, kadınların yaşamını olumsuz etkileyen, depresyon ve toplumdan soyutlanmaya neden olan hijyenik ve sosyal bir problemdir. %15 ila 52 lik prevalans oranı ile stres üriner inkontinans en sık karşılaşılan inkontinans tipidir. Gerek stres gerekse mikst tip üriner inkontinans gebelik esnasında görülebilmekle birlikte, vajinal doğumun pelvik tabanda yol açtığı travmayla ilişkili olan tipin stres üriner inkontinans olduğu kabul edilmektedir. Artan paritenin stres üriner inkontinans etyolojisindeki önemi hala tartışmalıdır. Çalışmamızın amacı, pelvik taban morfolojisi ve fonksiyonu üzerine vajinal doğumun etkisini, perineal ultrasonografi kullanarak araştırmak ve sezaryan ile doğum yapan kadınlarla kıyaslamaktır.
MATERYAL VE METOD: Hastalar, 32-39 uncu gebelik haftaları arasında ve doğum sonrası 9 uncu haftada olmak üzere iki kez değerlendirildi. Üriner inkontinans varlığı, antenatal ve postpartum olmak üzere her iki incelemede sorgulandı. Mesane boynunun lokalizasyonu Schaer ve arkadaşlarının tanımladığı x-y koordinat sistemi kullanılarak yapıldı. Gerek doğum öncesi, gerekse doğum sonrası mesane boynunun valsalva ile sefalokaudal, ventrodorsal ve vektörel olmak üzere üç boyutlu hareketi perineal ultrasonografi ile incelendi.
BULGULAR: Ölçümler multipar grupta primipar ve sezaryan grubuna göre istatistiksel olarak anlamlı düzeyde yüksek olarak bulundu. Aynı hareketler için primipar grup sezaryan grubu ile kıyaslandığında ise ölçümler primipar grupta istatistiksel olarak anlamlı ölçüde yüksek idi. Doğum sonrasında stres üriner inkontinansı olan olgular değerlendirildiğinde ise, mesane boynunun, hem doğum öncesi hem de doğum sonrası sefalokaudal, ventrodorsal ve vektörel yöndeki hareketi, inkontinans negatif olgulara göre pozitif olanlarda anlamlı oranda yüksek bulundu. Mesane boynu ve üretranın anatomik desteğinin, vajinal doğumdan etkilendiği bu çalışmada açık bir şekilde görülmektedir. Doğum öncesinde mesane boynu mobilitesi, hiç doğum yapmayan primigravida ve sezaryen grubu olgularda farklılık göstermezken, en az bir vajinal doğum yapmış olan olgularda artmıştır. Doğum sonrasında ise, vajinal doğum yapmış olgularda, hiç vajinal doğum geçirmemiş sezaryan grubu olgulara göre mobilite yüksek olarak bulunmuştur. GSİ doğum öncesi %33 iken doğum sonrası 9. haftada %51 olarak bulunmuş olup, postpartum de novo inkontinans % 47 oranındadır.
SONUÇLAR: İleri anne yaşı, artmış bebek doğum ağırlığı ve paritenin postpartum inkontinans için risk oluşturduğu sonucuna varılmıştır.

ABSTRACT
INTRODUCTİON: Stress urinary incontinence (SUI), the complaint of involuntary leakage of urine on effort or exertion, or on sneezing or coughing is the most common type of urinary incontinence, which causes depression and social problems in women. The most common type of incontinence is stress urinary incontinence with % 15-52 prevelance. Pelvic floor damage caused by vaginal delivery is one of the main causes of strss urinary incontinence. Increased parity as a cause of incontinence is still a matter of debate.
MATERİALS AND METHODS: Patients were first evaluated in 32-39 weeks of pregnancy, and later postpartum 9’th week. Urinary incontinence symptoms were questioned antenatally and postnatally. Bladder neck position was evaluated according to X-Y coordinate system described by Schaer et al. The cephalocaudal, ventrodorsal and vectorial three-dimensional movements of the bladder neck were measured with perineal ultrasonography before delivery and after delivery.
RESULTS: Bladder neck movement measurements were higher in the multiparous group, compared to primiparous delivery and elective cesarean delivery group respectively. There was a statistically significant difference between primiparous and cesarean group. Stress urinary incontinence positive group had significantly higher cephalocaudal, ventrodorsal and vectorial mobility both before and after birth evaluation, compared to stress incontinence negative group. The urethral support and pelvic floor strength may be damaged by vaginal delivery. Before delivery, bladder neck mobility was higher in multiparous group, compared to the other two groups. After delivery the mobility was found to be higher in vaginal delivery group compared to cesarean group. Genuine stress incontinence was %31 before delivery and %51 after delivery at 9’th week, so postpartum de novo incontinence was %47.
CONCLUSİON: Increased maternal age, increased parity and birth weight and existence of incontinence symptoms during pregnancy are risk factors for stress urinary incontinence.

References

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  • 2. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence : the hammock hypothesis. Am J obstet Gynecol 1994; 170(6): 1713-20.
  • 3. Petros PE. Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl 1993;153:1-93.
  • 4. Kalejaiye O. Vij M. Drake M. J. Classification of stress urinary incontinence. World J Urol. 2015 Vol. 33. pp. 1215-1220.
  • 5. McGuire EJ. Urodynamic findings in patients after failure of stress incontinence operations. Prog Clin Biol Res 1981;78: 351-360.
  • 6. Yang JM. Yang SH. Huang WC. Dynamic interaction involved in the tension free vaginal tape obturator procedure J Urol. 2008;180(5):2081-2087.
  • 7.Bussara S. Nucharee S. stress urinary incontinence in pregnant women: a review of prevalence. pathophysiology. and treatment. Int Urogynecol J (2013) 24:901-912.
  • 8.Van Brummen HJ. Bruinse HW. van de Pol G. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int 98(1):89-95.
  • 9.Snooks SJ. Setchell M. Swash M. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546-550.
  • 10. Hilton P. Dolan L. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG. 2004. Vol.111. pp. 5-9.
  • 11.De Araujo CC. Coelho SA et al. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review. Int Urogynecol J. 2018 May;29(5):639-645.
  • 12. Volloyhaug I. Van Gruting I et al. Is bladder neck and urethral mobility associated with urinary incontinence and mode of delivery 4 years after childbirth? Neurourol Urodyn. 2017 Jun;36(5):1403-1410.
  • 13. Dietz HP. Eldridge A. Grace M. et al. Pelvic organ descent in young nulligravid women. Am J Obstet Gynecol. 2004; 191(1):95-99.
  • 14.Bergman A. Office work up of lower urinary tract dysfunction and indication for referral for urodynamic tests. Obstet Gynecol Clin North Am. 1989;16:781-792.
  • 15. Al-Saadi. W.I. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles. Arab J. Urol. 2016.14.66-71.
  • 16.Dietz. H.P. Pelvic floor ultrasound in prolapse: What’s in it for the surgeon? Int. Urogynecol. J. 2011.22.1221-1232.
  • 17.McKinnie V. Swift SE. Wang et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol. 193(2):512-518.
  • 18.Wang H. Ghoniem G. Postpartum stress urinary incontinence. is it related to vaginal delivery? J Matern Fetal Neonatal Med. 2017 Jul;30(13):1552-1555
  • 19. Sangsawang B. Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. EJOG. July 2014 Vol.178.pp. 27-34.
  • 20.Groutz A. Rimon E. Peled S. Neurourol Urodyn. 2004;23(1):2-6.
  • 21.Nygaard I. Urinary incontinence: is cesarean delivery protective? Semin Perinatol. 2006 Oct;30(5):267-71.
  • 22. Santoro. G.A. Wieczorek. A.P. Bartram. C.I. Pelvic floor disorders: Imaging and multidisciplinary approach to management; Springer: Milano. Italy.2010; pp. 407-408.
  • 23.Viereck. V. Pauer H.U. et al. Urethral hypermobility after anti-incontinence surgery- A prognostic indicator? Int Urogynecol J. Pelvic Floor Dysfunction 2006 . 17. 586-592.
  • 24. Peschers U. Schaer G. Anthuber c. Changes in vesical neck mobility following vaginal delivery. Obstetrics and Gynecology 1996. Vol.88 No.6. pp.1001-1006.
  • 25.King J. Freeman R. Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? BJOG. Dec 1998. Vol. 105. pp. 1300-1307.
  • 26.Sultan AH. Kamm MA. Hudson CN. Pudendal nerve damage during labor: prospective study before and after childbirth. BJOG 1994;101: 22-28.
  • 27.Wilson PD. Herbison RM. et al. Obstetric practice and the prevalence of urinary incontinence three months after delivery. BJOG 1996;103:154-161.
  • 28.Wijma J. Annemarie E. Weis P. Anotomical and functional changes in the lower urinary tract following spontaneous vaginal delivery. BJOG: July 2003. Vol. 110. pp. 658-663.
  • 29. Thorp JM. Norton PA. Wall LL. Urinary incontinence in pregnancy and the puerperium: a prospective study. Am J Obstet Gynecol. 1999;181(2):266-273.
  • 30.Iosif CS. Ingemarsson I. Prevalence of stress incontinence among women delivered by elective cesarian. Int J Gynaecol Obstet 1982;20:87-89.
Year 2020, Volume: 17 Issue: 2, 349 - 353, 25.06.2020
https://doi.org/10.38136/jgon.670949

Abstract

References

  • REFERENCES 1. Abrams P. Cardozo L. et. al. Standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21:167-178.
  • 2. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence : the hammock hypothesis. Am J obstet Gynecol 1994; 170(6): 1713-20.
  • 3. Petros PE. Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl 1993;153:1-93.
  • 4. Kalejaiye O. Vij M. Drake M. J. Classification of stress urinary incontinence. World J Urol. 2015 Vol. 33. pp. 1215-1220.
  • 5. McGuire EJ. Urodynamic findings in patients after failure of stress incontinence operations. Prog Clin Biol Res 1981;78: 351-360.
  • 6. Yang JM. Yang SH. Huang WC. Dynamic interaction involved in the tension free vaginal tape obturator procedure J Urol. 2008;180(5):2081-2087.
  • 7.Bussara S. Nucharee S. stress urinary incontinence in pregnant women: a review of prevalence. pathophysiology. and treatment. Int Urogynecol J (2013) 24:901-912.
  • 8.Van Brummen HJ. Bruinse HW. van de Pol G. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int 98(1):89-95.
  • 9.Snooks SJ. Setchell M. Swash M. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet 1984;2:546-550.
  • 10. Hilton P. Dolan L. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG. 2004. Vol.111. pp. 5-9.
  • 11.De Araujo CC. Coelho SA et al. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review. Int Urogynecol J. 2018 May;29(5):639-645.
  • 12. Volloyhaug I. Van Gruting I et al. Is bladder neck and urethral mobility associated with urinary incontinence and mode of delivery 4 years after childbirth? Neurourol Urodyn. 2017 Jun;36(5):1403-1410.
  • 13. Dietz HP. Eldridge A. Grace M. et al. Pelvic organ descent in young nulligravid women. Am J Obstet Gynecol. 2004; 191(1):95-99.
  • 14.Bergman A. Office work up of lower urinary tract dysfunction and indication for referral for urodynamic tests. Obstet Gynecol Clin North Am. 1989;16:781-792.
  • 15. Al-Saadi. W.I. Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles. Arab J. Urol. 2016.14.66-71.
  • 16.Dietz. H.P. Pelvic floor ultrasound in prolapse: What’s in it for the surgeon? Int. Urogynecol. J. 2011.22.1221-1232.
  • 17.McKinnie V. Swift SE. Wang et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence. Am J Obstet Gynecol. 193(2):512-518.
  • 18.Wang H. Ghoniem G. Postpartum stress urinary incontinence. is it related to vaginal delivery? J Matern Fetal Neonatal Med. 2017 Jul;30(13):1552-1555
  • 19. Sangsawang B. Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. EJOG. July 2014 Vol.178.pp. 27-34.
  • 20.Groutz A. Rimon E. Peled S. Neurourol Urodyn. 2004;23(1):2-6.
  • 21.Nygaard I. Urinary incontinence: is cesarean delivery protective? Semin Perinatol. 2006 Oct;30(5):267-71.
  • 22. Santoro. G.A. Wieczorek. A.P. Bartram. C.I. Pelvic floor disorders: Imaging and multidisciplinary approach to management; Springer: Milano. Italy.2010; pp. 407-408.
  • 23.Viereck. V. Pauer H.U. et al. Urethral hypermobility after anti-incontinence surgery- A prognostic indicator? Int Urogynecol J. Pelvic Floor Dysfunction 2006 . 17. 586-592.
  • 24. Peschers U. Schaer G. Anthuber c. Changes in vesical neck mobility following vaginal delivery. Obstetrics and Gynecology 1996. Vol.88 No.6. pp.1001-1006.
  • 25.King J. Freeman R. Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? BJOG. Dec 1998. Vol. 105. pp. 1300-1307.
  • 26.Sultan AH. Kamm MA. Hudson CN. Pudendal nerve damage during labor: prospective study before and after childbirth. BJOG 1994;101: 22-28.
  • 27.Wilson PD. Herbison RM. et al. Obstetric practice and the prevalence of urinary incontinence three months after delivery. BJOG 1996;103:154-161.
  • 28.Wijma J. Annemarie E. Weis P. Anotomical and functional changes in the lower urinary tract following spontaneous vaginal delivery. BJOG: July 2003. Vol. 110. pp. 658-663.
  • 29. Thorp JM. Norton PA. Wall LL. Urinary incontinence in pregnancy and the puerperium: a prospective study. Am J Obstet Gynecol. 1999;181(2):266-273.
  • 30.Iosif CS. Ingemarsson I. Prevalence of stress incontinence among women delivered by elective cesarian. Int J Gynaecol Obstet 1982;20:87-89.
There are 30 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Selen Ecemis 0000-0002-5519-9497

Tolga Ecemis 0000-0002-7892-2254

Nese Yücel 0000-0002-5689-1311

Publication Date June 25, 2020
Submission Date January 6, 2020
Acceptance Date March 12, 2020
Published in Issue Year 2020 Volume: 17 Issue: 2

Cite

Vancouver Ecemis S, Ecemis T, Yücel N. The effect of vaginal delivery on stress urinary incontinence and bladder neck mobility: Transperineal ultrasound evaluation. JGON. 2020;17(2):349-53.