Editorial comment

Abstract

This report, once again, has demonstrated that we do not know how these operations do the positive things that they seem to do in most appropriately selected patients. The measurement of varying urethral urodynamic parameters to attempt to determine how the operation corrects stress urinary incontinence (SUI) is at present, in my opinion, ludicrous. Why is that, you ask? What is being measured does not answer the question because the entire process of SUI in women is not understood well enough as to its causation, which prevents the precise characterization of the dysfunction in SUI. We define SUI as the loss of urine occurring with increases in intra-abdominal pressure, not changes in urethral pressure. This implies that some level of intrinsic sphinteric deficiency is present in all cases of SUI which permits the urinary loss that occurs on increases in intra-abdominal pressure. No mention was made of urethral hypermobility in the definition of SUI, and we have all seen patients with SUI who do not have hypermobility, yet leak urine on coughing, and so forth. At present, all that we know is that mid-urethral slings work empirically for a large percentage of patients with SUI (and even better in those with urethral hypermobility). Urodynamic evaluations of the urethral closure mechanism have not been helpful (nor will they be helpful) in determining why this is the case. This is because we are interested in why the bladder outlet opens when it should not during increases in intra-abdominal pressure in patients with SUI. Put another way, we are interested in understanding the urethral opening mechanism, not its closure, with respect to treatment for SUI. This report can be added to the never-ending list of studies that have reported on a measurement in a specific group of patients undergoing treatment (in this case, a mid-urethral sling for SUI) that really does not do what the authors would really like to do, which is to help all of us understand the mechanism of the disorder we call SUI so that we can aim therapies more directly to an individual’s problem and not just accept empiric success. Effect of tension-free vaginal tape operation on urethral closure functionUrologyVol. 67Issue 3PreviewTo evaluate whether the tension-free vaginal tape operation changes urethral hypermobility, funneling, and urethral urodynamic parameters in different parts of the urethra. Full-Text PDF