الفهرس 
Pathophysiology ofOnly 14 pages are availabe for public view
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Abstract
Urinary incontinence is defined by the International Continence Society (ICS) as the complaint of any involuntary leakage of urine. Stress urinary incontinence (SUI) is the most common form of urinary incontinence in women and is particularly common in younger women. Evidence suggests that Cesarean delivery can protect women against urinary incontinence. The Royal College of Obstetricians and Gynaecologists (RCOG) stated in their National Evidence-Based Guidelines for Cesarean Section (CS) that women who deliver vaginally has an absolute risk of subsequently developing urinary incontinence of 7.3%, compared with 4.5% in women who deliver by CS; and that the relative risk (CS vs. vaginal delivery) is 0.6 [95% CI (0.4 to 0.9)] which is statistically significant. Nevertheless, many studies were inconclusive and even showed no difference concerning mode of delivery and subsequent risk of developing urinary incontinence. Most of these studies are symptoms-based diagnosis and did not depend on urodynamic conformation. Therefore, there is a need to have an assessment of the relationship between the mode of delivery and subsequent urinary incontinence in Egyptian women who present to Ain Shams University Maternity Hospital.
This was a case-control study that was done at Ain Shams University Maternity Hospital to retrospectively assess the relationship between development of female urinary incontinence and the mode of Delivery. The study included women who were admitted to Ain Shams University Maternity Hospital, for having stress urinary incontinence, over a 5-year period, between January 2005 and December 2009. A second group of matched women with no complaint of SUI and came to outpatients clinic for reasons other than urinary incontinence as a control group. Inclusion criteria: premenopausal state; and significant complaint of stress urinary incontinence affecting general hygiene of the patient and socially unacceptable, which necessitated evaluation by urodynamics, and was proven to have either urodynamic stress incontinence, overactive bladder or mixed form of urinary incontinence. Postmenopausal women, women with chronic systemic disease causing overactive bladder e.g. diabetes mellitus, chronic obstructive airway disease e.g. bronchial asthma or emphysema, past history of pelvic surgery other than cesarean section. Data was collected from patient records available at ”Patient Records Department” at Ain-Shams University Maternity Hospital. Missing data was collected through phone calls or direct contact with the patients.
The study included 2 groups of women: group I (study group) [n=80]: women who were admitted for having a complaint of stress urinary incontinence, and group II (control group) [n=80]: women who came to outpatient clinic for reasons other than urinary incontinence and had a normal urodynamic study. The mean age was 31.94 ± 5.44 years (range: 18 – 45 years). The median parity was 2 (range: 1 – 5).
There was a significantly higher proportion of vaginal deliveries and a significantly lower proportion of Cesarean sections among women who had stress urinary incontinence, when compared to women of the control group [66/80 (82.5%) vs. 41/80 (51.3%) and 14/80 (17.5%) vs. 39/80 (48.7%), respectively, p<0.001]. Vaginal delivery was associated with nearly 4-times higher risk of stress urinary incontinence than Cesarean section [odds ratio = 3.86, 95% CI (1.87 to 7.79)]. Parity was also associated with higher risk of stress urinary incontinence [odds ratio = 1.2, 95% CI (0.7 to 4.9)].
In conclusion, vaginal delivery especially operative vaginal delivery seems to be the significant risk factor associated with subsequent development of urinary incontinence.