Abstract
To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Mean follow-ups were 32 +/- 12 months (range 12-55) for TVT and 31 +/- 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP < or = 60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP < or = 60 cm H2O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82% vs. 68.9% p < 0.172); VLPP < or = 60 cm H2O (68% vs. 76% p < 0.528). When patients were stratified for preoperative VLPP (< or = or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.
Highlights
Since the tension-free vaginal tape (TVT) procedure was first described by Ulmsten et al in1996 [1], mid-urethral sling procedures have been established as safe and effective in the treatment of female stress urinary incontinence (SUI) [2]
When patients were stratified for preoperative Valsalva leak point pressure (VLPP) (≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or transobturator tape (TOT) procedures
Preoperative urodynamic parameters were similar in the two groups, except for detrusor overactivity, which was more frequent in patients who received TOT (Table-2)
Summary
When patients were stratified for preoperative VLPP (≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.
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