Abstract
To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30° on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.
Highlights
Stress urinary incontinence (SUI) is a significant health problem worldwide, affecting up to 30% of adult women [1]
The most accepted theory, the “hammock theory”, states the urethra is closed during straining as a result of compression against a hamibju | urethral mobility and valsalva leak point pressure for transobturator sling procedure mock-like, supporting layer of connective tissue, and not by assuming truly intra-abdominal position, as previously thought [2]
This study aims to analyze independent influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence in the same group of patients
Summary
Stress urinary incontinence (SUI) is a significant health problem worldwide, affecting up to 30% of adult women [1]. The most accepted theory, the “hammock theory”, states the urethra is closed during straining as a result of compression against a hamibju | urethral mobility and valsalva leak point pressure for transobturator sling procedure mock-like, supporting layer of connective tissue, and not by assuming truly intra-abdominal position, as previously thought [2]. Base on this hypothesis, mid-urethral sling procedures were introduced, providing reinforcement of a defective suburethral support rather than correcting hypermobility, leading bladder neck procedures to be virtually abandoned [3]. This study aims to analyze independent influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence in the same group of patients
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