A two-page questionnaire was distributed to 304 members of the American Urogynecology Society. Ninety-nine of the 149 respondents reported that they had performed continence surgery on patients who specifically stated their desire for future childbearing. One hundred and eleven recommended the Burch colposuspension, 29 favored the sling procedure, and others advocated different procedures. Urologists as a subset more often recommended either a sling or needle suspension. Twenty-eight percent of respondents felt a trial of labor and vaginal delivery was indicated following incontinence surgery, but 40% stated that they would always perform cesarean section in these patients. A total of 40 vaginal deliveries and 47 cesarean sections were reported. When postpartum continence status was known, only 73% of women who had vaginal deliveries were continent, whereas 95% were continent following cesarean section. Fisher's exact test revealed this to be a statistically significant difference (
P=0.0344).
Keywords Childbearing - Incontinence surgery - Pregnancy
The opinions expressed in this article do not reflect the views or opinions of the United States Navy or the Department of Defense.
Editorial Comment: This study presents interesting information about current practice trends regarding a difficult medical situation without any clear guidelines. However, whether any true clinical consensus was reached based on the data collected is questionable. The study does, however, serve to open the topic of how to manage the incontinent female who desires further childbearing, for further study. Clearly, more rigorous objective data are needed before far-reaching statements can be made regarding the route of delivery following incontinence surgery.