By Deborah Brauser
ATLANTA -- October 26, 2009 -- Visceral peritoneal closure performed during Caesarean section (CS) is associated with more frequent postpartum urinary symptoms compared with non-closure, according to results from a large randomised study presented here at the American Society for Reproductive Medicine (ASRM) 65th Annual Meeting.
"Few studies have assessed the effect of visceral peritoneal manipulation on post-Caesarean urinary complaints," said lead investigator Ahmed Youssif Shahin, MD, Faculty of Medicine and Women's Health Center, Assiut University, Assiut, Egypt, during his October 20 poster presentation.
"For this study, we hypothesised that upward bladder traction by visceral closure might predispose to postpartum urinary symptoms through a change in the urethrovesical angle," said Dr. Shahin.
The investigative team enrolled 620 women from the Women's Health Center, Assiut, Egypt, who were pregnant for the first time and had indications for CS early in labour. None had urinary manifestations at enrolment.
The women were randomised to undergo elective CS with or without visceral peritoneal closure. At 1 and 6 months postpartum, all patients answered the Postpartum Urinary Dysfunction Inventory short form-6 questions by telephone. In addition, the sonographic posterior urethrovesical angle, bladder neck descent below symphysis pubis, and alpha angle were measured and compared pre-birth and 48 hours postpartum by ultrasound scan.
At the end of the study, the investigators found that the women undergoing closure had a significant (P < .01) widening of the posterior urethrovesical and alpha angles from the preoperative level compared with those in the non-closure group and a lower descent of the bladder neck below symphysis pubis.
After 1 month of surgery, the closure group also had a significantly higher incidence of frequency (P < .001), urge (P < .001), and stress incontinence (P < .05) than the non-closure patients. However, at the 6-month evaluation, these differences were no longer significant, and the symptoms disappeared almost completely.
"The [results at 6 months were] explainable by the surgical manipulation's possible creation of subperitoneal pockets, which are predisposed to harbouring bacteria leading to infection for a short period," explained Dr. Shahin.
He concluded that "clinicians should not be very enthusiastic about doing these closures during Caesarean section, especially in patients who are undergoing [CS] for the first time." Dr. Shahin added that closure might predispose the patient "to unnecessary postpartum urinary symptoms; although, they do disappear almost completely without treatment within a few months."
[Presentation title: Assessment of Post-Cesarean Incontinence and Perineal Ultrasonographic Changes Following Visceral Peritoneal Closure vs Non-Closure -- A Randomized Trial. Abstract P-133]
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