MP46-18 A LOGISTIC REGRESSION PREDICTION MODEL FOR THE SUCCESS OF THE MALE TRANSOBTURATOR SLING; VALSALVA LEAK-POINT PRESSURE (VLPP) GREATER THAN 70 CM H2O IS AN INDICATOR FOR SLING SUCCESS

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-18 A LOGISTIC REGRESSION PREDICTION MODEL FOR THE SUCCESS OF THE MALE TRANSOBTURATOR SLING; VALSALVA LEAK-POINT PRESSURE (VLPP) GREATER THAN 70 CM H2O IS AN INDICATOR FOR SLING SUCCESS Divya Ajay and Andrew Peterson Divya AjayDivya Ajay More articles by this author and Andrew PetersonAndrew Peterson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1457AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urodynamic studies are often performed in the evaluation of post-prostatectomy stress urinary incontinence (PPSUI). The male transobturator sling (TOS) is a minimally invasive treatment for PPSUI. Many have reported their results with the specific Valsalva leak point pressure (VLPP) that predicts a good response to the TOS. Our objective was to determine the relationship of the pre-operative VLPP on the success rate of the male TOS in a high volume, single center. We hypothesized that the preoperative VLPP of 60cmH2O may better predict successful outcomes in these patients. METHODS We reviewed patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent TOS placement were identified using our patient data portal (DEDUCE). Demographic, urodynamic, and follow-up data were extracted by chart review. Post-operative success was defined by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g per 24 hours. Cox regression model and Kaplan Meier Survival analysis were performed. RESULTS 290 patients were included. All patients had undergone a radical prostatectomy for prostate cancer and presented with PPSUI. Average age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5 months (IQR 1-15). Figure 1 shows an inverse prediction curve for sling failure versus VLPP. The hazard ratio for failure with a VLPP of ≤70 cm H2O compared with a VLPP of >70 cmH2O, adjusted for pelvic radiation and 24 hour pad weight was 0.5 (95%CI 0.27-0.98). CONCLUSIONS There have been numerous papers written on the importance of patient selection for male TOS. We also know that men prefer a sling over an AUS. In our cohort of patients with PPSUI, those with a pre-procedural VLPP of > 70 cm H2O were 50% less likely to fail after TOS placement versus those with a VLPP ≤70 cm H2O. In our practice, we use this data to supports the use of VLPP cut off of 70 cm H2O as an indicator for success to help in the evaluation and counselling of patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e626-e627 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Divya Ajay More articles by this author Andrew Peterson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...