Episiotomy, urinary incontinence, and pelvic organ prolapse: is it time for an update?
IUGA Academy. Weintraub A. 06/30/18; 212833; 420 Topic: Pelvic Organ Prolapse
Dr. Adi Y Weintraub
Dr. Adi Y Weintraub

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Episiotomy, urinary incontinence, and pelvic organ prolapse: is it time for an update?

Frigerio, M1; Mastrolia, SA2; Spelzini, F3; Manodoro, S3; Yohay, D4;Weintraub, AY4

1: ASST Monza; 2: Fondazione monza e brianza per il bambino e la sua mamma; 3: AUSL Romagna; 4: Ben-Gurion University of the Negev, Beer-Sheba, Israel.

Introduction: Pelvic floor disorders (PFD), such as urinary incontinence (UI) and pelvic organ prolapse (POP) are primarily related to vaginal delivery. Therefore, it is of the utmost importance to identify risk factors for PFD among obstetrical interventions during vaginal birth. In particular, the role of episiotomy in the prevention of PFD is controversial.

Objective: Our aim was to focus on the long term effects of episiotomy on UI and POP systematically reviewing the best available evidence. Specifically, we sought to describe outcomes such as prevalence, severity, and surgical interventions for UI and POP conditions.

Methods: This systematic review was conducted according to PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses. Studies assessing the long term effect of episiotomy on PFD were included. Only studies with a mean follow-up ≥5 years were included in order to assess the long term effects of episiotomy. To identify potentially eligible studies, we searched PubMed, Scopus, Cochrane Library and ISI Web of Science (up to August 31, 2017). We used a combination of key words and text words represented by “episiotomy”, “perineal tear”, “perineal laceration”, “perineal damage” and “long term”, “long term outcomes”, “prolapse”, “pelvic organ prolapse”, “pelvic floor”, “pelvic floor dysfunction”, “urinary incontinence”, “cystocele”, “hysterocele” and “rectocele”. Two reviewers independently screened titles and abstracts of records retrieved through database searches. Full texts of records recommended by at least one reviewer were screened independently by the same two reviewers and assessed for inclusion in the systematic review. In addition reviews, letters to Editor, conference abstracts, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded.

Results: The electronic database search provided a total of 6154 results. After duplicate exclusion, 1268 studies remained. Of them, based on title and abstract screening, 1128 were excluded due to lack of relevance to the topic. One hundred-forty studies were considered for full text assessment, of which 117 were excluded according to inclusion/exclusion criteria. Overall, 23 studies met the inclusion criteria and were incorporated for final assessment.

Conclusions: We reviewed the available evidence for the long term impact of episiotomy on PFD (UI and POP) with the following results: 1) Episiotomy has a negative effect, including both stress and urge UI; 2) Conversely, the relationship between episiotomy and anti-incontinence surgery is less clear due to contradicting reports; 3) Episiotomy does not seem to negatively affect prolapse development and might even be protective with respect to prevalence and severity; 4) Episiotomy does not seem to affect prolapse surgery rate.

The effect of episiotomy in the prevention of PFD needs to be studied in a specifically targeted RCT before further conclusions can be made. Until farther results are available to elucidate these questions, episiotomy should be continued to be practiced based on obstetrical indications alone.


Work supported by industry: no.

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