Female urinary incontinence. A study on heredity, urodynamic and hormonal factors and the evaluation of a novel surgical technique

Abstract: Abstract Pelvic floor disorders (PFD) represent a major public health issue worldwide. Aims of this work Study I: to investigate associations between preoperative resting urethral parameters (MUCP, FL and CA) and objective outcome of laparoscopic colposuspension and, if possible, to identify cutoff values useful in clinical practice. Study II: to investigate a group of perimenopausal women reporting UI regarding possible differences in serum estradiol levels among the different incontinence types. Studies III and IV: to compare retropubic TVT® with the novel TVT Secur® as surgical treatment options for SUI in terms of efficacy and safety. Study V: to estimate the degree of familial predisposition for PFD and the influence of other risk factors such as aging and parity in a Swedish population. Material and methods Study I: prospectively collected register data on 219 women with SUI operated with laparoscopic colposuspension between 1994 and 2004. Associations between objective cure and preoperative urethral parameters at rest were analyzed. Study II: clinical and laboratory data from the observational population-based ‘‘Women’s Health in the Lund Area’’ (WHILA) study, where a group of 400 perimenopausal women reporting UI answered a detailed questionnaire on their incontinence symptoms; answers were related to their serum estradiol levels. Studies III and IV: patients with primary SUI or MUI with predominant SUI symptoms were randomized between TVT and TVT Secur. Adverse events were registered and post operative outcome was blindly assessed two months (subjective cure of SUI) and one year after surgery (subjective and objective cure). Study V: Two Swedish national registers, the Hospital Discharge Register and the the Multi-Generation Register were used for the analysis. We estimated the number of women (probands), given a specific age and final parity, which were at risk and how many of them had been identified from the Hospital Discharge Register as operated for PFD. This quotient was applied to the number of relatives of that age and parity, and an expected number of operated women of each group of relatives (mothers or sisters) was calculated and compared with the observed number. A risk ratio (RR) was calculated as the quotient between the observed and expected numbers (stratified by proband age and final parity at the time of the proband’s operation and adjusting for parity in the analysis of age and for age in the analysis of parity). Results and conclusions Study I: we were not able to identify any cutoff values for MUCP, FL or CA that could be used as predictor for outcome after laparoscopic colposuspension. A combination of MUCP, FL, CA may be used to identify patients with an increased risk for surgical failure. Study II: no difference in serum estradiol levels was found among women around menopause suffering from different types of incontinence. Studies II and IV: the TVT Secur was less effective for treating SUI (both subjective and objective cure rates) and did not result in fewer complications when compared with the TVT. Study V: first grade female relatives to women operated for PFD suffer a two- to five-fold increased risk for surgery for the same conditions. Heredity seems to play a lesser role with increasing age and parity. The RR was similar for the different pelvic floor compartments within a group, suggesting a general pelvic floor disorder among relatives.