Incidence and risk factors for reoperation of surgically treated urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The objective of our study was to estimate the incidence and to identify the risk factors for reoperation of surgically treated stress urinary incontinence (SUI). METHODS: We conducted a nested case-control study among 1,132 women who underwent SUI surgery from January 1988 to June 2007. Cases (n=35) were women who required reoperation for SUI following the first intervention up to December 2008. Controls (n=89) were women randomly selected from the same cohort who did not require reoperation. RESULTS: The cumulative incidence of SUI reoperation was 3.1 % with a mean follow-up of 10.9 years (range 1.7-21.0). The main risk factor was the history of more than one vaginal delivery [adjusted odds ratio (OR) 3.5; 95 % confidence interval (CI) 1.0-12.6]. The use of synthetic midurethral slings was a protective factor compared to other surgical procedures for urinary incontinence (adjusted OR 0.1; 95 % CI 0.0-0.6). CONCLUSIONS: The risk of reoperation after SUI surgery appears to be low and associated with multiple vaginal deliveries. Synthetic slings at index surgery are associated with a lower risk of reoperation.

Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: The objective of our study was to estimate the incidence and to identify the risk factors for reoperation of surgically treated pelvic organ prolapse (POP). METHODS: We conducted a nested case-control study among 1,811 women who underwent POP surgery from January 1988 to June 2007. Cases (n = 102) were women who required reoperation for POP following the first intervention through December 2008. Controls (n = 226) were women randomly selected from the same cohort who did not require reoperation. RESULTS: The incidence of POP reoperation was 5.1 per 1,000 women-years. The cumulative incidence was 5.6%. Risk factors included preoperative prolapse in more than two vaginal compartments (adjusted OR 5.2; 95% CI 2.8-9.7), history of surgery for POP and/or urinary incontinence (adjusted OR 3.2; 95% CI 1.5-7.1), and sexual activity (adjusted OR 2.0; 95% CI 1.0-3.7). CONCLUSIONS: The risk of POP reoperation is relatively low and is associated with preexisting weakness of pelvic tissues.

[Pain medication during pregnancy]. / Antalgie médicamenteuse et grossesse.

To treat pain that does not respond to non-pharmacological approaches in a pregnant woman represents a challenge for the primary care physician. He is often the first health professional to be consulted and finds himself confronted to not only one but two patients:the mother and the fetus. His knowledge on pain treatment and the practical approach that he is used to, will have to be adapted to this new equation. He will have to weigh the benefit for the mother against the risk for the fetus, while creating a true relationship with his patient. Although only a few drugs are considered compatible with pregnancy, the data available from the literature allow nowadays to better understand the nature of the risk when exposing the fetus to a given drug and to elaborate evidence-based recommendations.