The role of maximal urethral closure pressure in predicting the outcomes of trans-obturator tape operation

OBJECTIVE

To investigate the role of preoperative maximal urethral closure pressure (MUCP) in predicting postoperative outcomes of trans-obturator tape (TOT) operation.

STUDY DESIGN

82 patients who underwent TOT surgery due to urodynamically proven stress urinary incontinence were retrospectively analyzed. Preoperative and 6th month postoperative results of cough stress tests (CST), Turkish validated Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) quality of life (QOL) questionnaires were recorded. Patients who had negative CST and more than 50% improvement in the QOL questionnaires in the postoperative evaluation were classified as cured.

RESULTS

14 (17.1 %) patients had MUCP ≤ 20 cmH2O, 68 (83 %) patients had MUCP > 20 cmH2O. The postoperative IIQ-7 and UDI-6 QOL scores were significantly improved compared to preoperative values in both MUCP ≤ 20 cmH2O and MUCP > 20 cmH2O groups. However, cure rate was lower in the MUCP ≤ 20 cmH2O group than in MUCP > 20 cmH2O group (35.7 % vs 83.8 %, respectively). Preoperative MUCP measurement and urethral mobility assessment were found to be independent factors associated with surgical outcome. A preoperative MUCP ≥ 28.5 cmH2O could predict surgical success after TOT with 92.6 % sensitivity and 85.7 % specificity.

CONCLUSIONS

TOT is a reliable method that has a high efficacy in the surgical treatment of stress urinary incontinence in short-term. Patients with low MUCP can also benefit from TOT. However, the success rate of TOT surgery decreases in the presence of low MUCP and absence of hypermobile urethra.

Can intrinsic sphincter deficiency be diagnosed by urodynamics?

Intrinsic sphincter deficiency (ISD) is a pathologic condition that is diagnosed by using urodynamics to measure Valsalva leak point pressure and maximal urethral closure pressure. The diagnosis can be difficult to reach given natural discrepancies in these values in women of different age groups and with varying degrees of incontinence. By standardizing urodynamic methodologies and interpretations to better diagnosis women with ISD, it may be possible to improve preoperative planning and outcomes for these patients treated surgically with synthetic midurethral slings.