De novo urethral hypermobility at 6 months after first delivery as a risk factor for stress urinary incontinence 12 years postpartum.

OBJECTIVE: The aim of the study was to analyze the association between de novo urethral hypermobility 6 months postpartum and stress urinary incontinence (SUI) symptoms at 6 months and 12 years after first delivery. Risk factors associated with the development of postnatal urethral hypermobility were also examined. METHODS: A longitudinal cohort study was conducted on primigravid women, after excluding those with UI before pregnancy and/or urethral hypermobility (rotational angle ≥30°) at term. At 6 months postpartum, SUI was assessed based on symptoms and introital ultrasound performed to measure rotational angle (difference between urethro-pelvic angle at rest and at maximum Valsalva). Twelve years after delivery, women were sent a questionnaire including SUI assessment and questions on parity, current age, and body mass index. Continuous variables were compared using student's t-test and qualitative variables using chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (P < 0.05) in the univariate analysis. RESULTS: Of the 314 women who completed the 6-month follow-up, 265 (84.4%) were successfully contacted and completed the questionnaire at 12 years and these formed the study group. In 127 women (47.9%), de novo urethral hypermobility had developed by 6 months postpartum. There was no association between urethral hypermobility and SUI symptoms 6 months postpartum (OR: 1.17; 95% CI: 0.59-2.33). Twelve years after delivery, however, SUI was reported by 110 women overall (41.5%) and nearly half of the women who developed postnatal urethral hypermobility (61/127, 48.0%). CONCLUSION: De novo urethral hypermobility 6 months postpartum constitutes a risk factor for SUI 12 years later.

Risk factors associated with stress urinary incontinence 12 years after first delivery.

INTRODUCTION AND HYPOTHESIS: This study was aimed at investigating risk factors involved in stress urinary incontinence (SUI) 12 years after first delivery. We also evaluated cumulative incidence, severity, and impact on quality of life (QoL) of SUI. We hypothesized that changes during the first pregnancy might be associated with SUI long after delivery. METHODS: A longitudinal cohort study was undertaken including primigravid women who delivered in our hospital during 2007. SUI was assessed following definitions of the International Continence Society. Severity was evaluated using the Incontinence Severity Index and impact on QoL with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Comparisons between continuous variables were performed using Student's t test and between qualitative variables using Chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (p < 0.05) in the univariate analysis. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up, and 318 completed the questionnaires 12 years after and formed the study group. The cumulative incidence of SUI at 6 months and 12 years postpartum was 14.2% and 39.6% respectively. Generally, SUI severity was slight (73.0%) or moderate (28.9%) and its impact on QoL was low. Pregnancy SUI (OR: 2.14; 95% CI: 1.29-3.55) was independently associated with SUI 12 years postpartum. CONCLUSION: The cumulative incidence of SUI increases markedly from 6 months to 12 years postpartum, being slight or moderate in severity and having a low impact on QoL in most cases. Developing SUI during pregnancy doubled the risk of SUI 12 years postpartum.

Leiomiosarcoma retroperitoneal tras tumor de músculo liso de potencialmaligno incierto / Retroperitoneal leiomyosarcoma developing after uterine smoothmuscle tumor of uncertain malignant potential

Los tumores de músculo liso no siempre son fácilesde clasificar. Presentamos un caso de tumor demúsculo liso de potencial maligno incierto que tras16 meses de la cirugía ha metastatizado como unleiomiosarcoma retroperitoneal en la fosa obturatrizizquierda (AU)

Uterine smooth-muscle tumors are not easy toclassify. We report a case of uterine smooth-muscletumor of uncertain malignant potential, whichmetastasized to retroperitoneal leiomyosarcoma inthe left obturator cavity (AU)