The management of urogynaecological problems in pregnancy and the early postpartum period


Dear Sir

Given that pregnancy alters both physiological and anatomical parameters, it is pleasing to read an article on urogynaecological problems specifically relating to pregnancy and the puerperium.[1] We were concerned that the section on success rates following repeat colposuspension after failed primary surgery lacks clarity. The figure of 81% after the first procedure refers not to the primary colposuspension but after the first repeat procedure and the figure of 25% after the second repeat (third colposuspension) procedure.[2] Robinson and Cardozo summarise nine studies on the objective outcome of redo colposuspension[3] suggesting cure rates of between 65 and 86% following repeat colposuspension. Similar success rates have also been reported following repeat midurethral sling procedures. Rezapour and Ulmsten[4] report an 82% cure rate following the retropubic tension-free vaginal tape procedure in the treatment of recurrent urinary stress incontinence, with success also being reported in women with more than one prior procedure. Whilst retropubic tape procedures demonstrate similar continence rates after failed procedures, transobturator tapes appear less successful. Stav et al.[5] report a statistically greater subjective cure rate in women who underwent the retropubic sling as a repeat procedure compared with the transobturator sling, irrespective of previous procedure (71% vs 48%, P = 0.04). Recent evidence suggests that subjective cure rates of 85% can be achieved when open colposuspension is used after an unsuccessful primary tape procedure although the development of de novo detrusor overactivity, known to be increased in patients undergoing repeat surgery, can be as high as 30%.[6]