Abstract
INTRODUCTION AND OBJECTIVES: To determine if changes in urodynamics (UDS) parameters after midurethral sling (MUS) differ between retropubic midurethral sling (RMUS) and transobturator midurethral sling (TMUS) procedures and whether they are associated with successful treatment outcomes. METHODS: The Trial of Midurethral slings (TOMUS) was a prospective randomized equivalence trial conducted at 9 sites, comparing 12 month subjective and objective outcomes of RMUS and TMUS. 597 women were randomized to RMUS or TMUS and underwent standardized UDS before and 12 months after surgery. UDS parameters are listed in table. Objective outcomes included: 300 cc bladder stress test, 24 hour pad test and stress urinary incontinence (SUI) re-treatment. Subjective outcomes included:self report of SUI, 3 day voiding diary and re-treatment of SUI. Linear models were fit to assess change in UDS measures from baseline to 12 months by treatment group and success status. Contingency tables were constructed for categorical measures; chi-square tests were used to test for associations. RESULTS: See Table. After MUS, both maximum and average uroflow rates were decreased, sensations were delayed and maximum urethral closure pressure (MUCP) decreased with no change in urethral length, Qmax was deceased while Pdet@Qmax slightly increased. No differences in UDS parameters between procedures were seen and no changes in UDS parameters correlated highly with either subjective or objective outcomes. Rates of denovo detrusor overactivity (DO) was similar between both procedures (p .61) and no difference was seen in the rates of resolution of DO (p .79). CONCLUSIONS: MUS procedures were associated with decreased flow rates and minimal increases in voiding pressures. Interestingly, no changes in urethral closure pressures were seen. Changes in UDS parameters did not differ by treatment group and were not associated with MUS subjective or objective outcomes.
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