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International Urogynecology Journal

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01-09-2019 | Incontinence Surgery | Original Article

Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase

Authors: Franca Natale, Ester Illiano, Alessandro Zucchi, Matteo Balzarro, Chiara La Penna, Elisabetta Costantini

Published in: International Urogynecology Journal | Issue 9/2019

Abstract

Introduction and hypothesis

To assess whether detrusor underactivity (DU) is a risk factor for voiding dysfunction (VD) after transobturator tape (TOT) and if a detrusor pressure at maximum flow (PdetQmax) value predicts postoperative VD in DU patients. Also, we examined uncomplicated patients for postoperative VD.

Methods

This is a prospective long-term study on SUI patients who underwent TOT. Exclusion criteria were preoperative POP stage ≥ 2, previous anti-incontinence surgery and comorbidities.

Patients were grouped by detrusor contractility using the projected isovolumetric pressure (PIP) index (PdetQmax + maximum flow rate) with values of 30–75 cmH₂O indicating normal contractility.

Follow-up was at 1, 3, 6 and 12 months, and then annually. All patients underwent a stress test and responded to the Urogenital Distress Inventory questionnaire and to the King’s Health Questionnaire. The subjective cure was evaluated using the Patient Global Impression of Improvement.

We determined the diagnostic accuracy of PdetQmax levels using ROC curve analysis, with a cut-off point calculated for optimal sensitivity and specificity.

Results

In 2007–2013, 118 patients underwent TOT. We included 50 in the undercontractility group (G1) and 50 in the normocontractility group (G2).

Continence rates were 82% in G1 and 84% in G2 (mean follow-up 76 months). VD increased from 18 to 36% (p < 0.05) in G1 and from 14 to 16% (p = 0.198) in G2. De novo VD was 28% in G1 and 2% in G2.

In the G1 group PdetQmax ≤ 12 cmH₂O predicted postoperative VD with 71.4% specificity and 80.0% sensitivity.

Conclusions

DU adversely affects the voiding phase of micturition after TOT. In DU patients, PdetQmax ≤ 12 cmH₂O predicts postoperative VD.

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Title: Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase
Authors: Franca Natale
Ester Illiano
Alessandro Zucchi
Matteo Balzarro
Chiara La Penna
Elisabetta Costantini
Publication date: 01-09-2019
Publisher: Springer International Publishing
Keywords: Incontinence Surgery
Stress Incontinence
Overactive Bladder
Voiding Disorder
Published in: International Urogynecology Journal / Issue 9/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-03871-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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