Risk Factors for Developing De Novo Stress Urinary Incontinence Following Pelvic Organ Prolapse Surgery: A Case-Control Study

Teerapan Seehanantawong; Siraya Kitiyodom

doi:10.64960/srimedj.v41i2.270427

Authors

Teerapan Seehanantawong Department of Obstetrics and Gynaecology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand 30000
Siraya Kitiyodom Department of Obstetrics and Gynaecology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand 30000

DOI:

https://doi.org/10.64960/srimedj.v41i2.270427

Keywords:

de novo stress urinary incontinence, pelvic organ prolapse surgery, risk factors, chronic constipation, body mass index

Abstract

Objective: To identify risk factors associated with the development of de novo stress urinary incontinence (SUI) in continent women undergoing pelvic organ prolapse (POP) surgery.

Methods: A retrospective case-control study was conducted at Maharaj Nakhon Ratchasima Hospital, a tertiary care center. Medical records of women who underwent POP surgery between June 2014 and June 2024 were reviewed. A total of 411 patients were included. Cases (n = 137) were defined as women who developed de novo SUI after surgery, whereas controls (n = 274) were continent women matched at a 2:1 ratio. Logistic regression analyses were performed to evaluate associations between clinical and demographic variables and the occurrence of postoperative de novo SUI. The main outcome measures are identification of clinical and demographic factors associated with the development of de novo SUI following POP surgery in previously continent women.

Results: In univariate analysis, age <65 years, BMI >27 kg/m², chronic obstructive pulmonary disease (COPD), chronic constipation, and voiding dysfunction symptoms were significantly associated with de novo SUI. In the multivariate model, BMI >27 kg/m² (adjusted OR 2.62; 95% CI 1.04–6.60; p = 0.041) and chronic constipation (adjusted OR 2.65; 95% CI 1.67–4.21; p < 0.001) remained independent predictors, whereas other variables did not retain statistical significance.

Conclusions: High BMI and chronic constipation were identified as significant risk factors for postoperative de novo SUI, underscoring the importance of tailored preoperative risk assessment. These predictors may inform surgical decision-making, including selective consideration of concomitant anti-incontinence procedures in high-risk individuals. Addressing modifiable risk factors prior to surgery may reduce the occurrence of de novo SUI and improve quality of life in women undergoing pelvic reconstructive surgery.

References

Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 2005;112(7):971–6. doi:10.1111/j.1471-0528.2005.00568.x.

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010;21:5–26. doi:10.1002/nau.20798.

Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct 2008;19(5):607–4. doi:10.1007/s00192-007-0498-2.

Groutz A, Levin I, Gold R, Pauzner D, Lessing JB, Gordon D. “Inside-out” transobturator tension-free vaginal tape for management of occult stress urinary incontinence in women undergoing pelvic organ prolapse repair. Urology 2010;76(6):1358–61. doi:10.1016/j.urology.2010.04.070.

Ennemoser S, Schönfeld M, von Bodungen V, Dian D, Friese K, Jundt K. Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term follow-up. Int Urogynecol J 2012;23(7):851–5. doi:10.1007/s00192-012-1765-4.

Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 2012;366(25):2358–67. doi:10.1056/NEJMoa1111967.

Wang SY, Cao TT, Wang RZ, Yang X, Sun XL, Wang JL. Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction: A Nested Case-control Study. Chin Med J (Engl) 2017;130(6):678–83. doi:10.4103/0366-6999.201592.

Fatton B. Is there any evidence to advocate SUI prevention in continent women undergoing prolapse repair? An overview. Int Urogynecol J Pelvic Floor Dysfunct 2009;20(2):235–45. doi:10.1007/s00192-008-0734-4.

Haessler AL, Lin LL, Ho MH, Betson LH, Bhatia NN. Reevaluating occult incontinence. Curr Opin Obstet Gynecol 2005;17(5):535–40. doi:10.1097/01.gco.0000183530.03481.64.

Chaikin DC, Groutz A, Blaivas JG. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163(2):531–4.

Sun X, Wang S. Analysis of de novo SUI after pelvic reconstructive surgery. Chin J Obstet Gynecol 2013;14:102–5.

Bergman A, Koonings PP, Ballard CA. Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapse. Am J Obstet Gynecol 1988;158(5):1171–5. doi:10.1016/0002-9378(88)90248-7.

Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009;360(5):481–90. doi:10.1056/NEJMoa0806375.

Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.