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International Urogynecology Journal

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01-10-2016 | Original Article

Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? A time to revisit

Authors: Monika Vij, Anupreet Dua, Robert M. Freeman

Published in: International Urogynecology Journal | Issue 10/2016

Abstract

Introduction and hypothesis

Maximum urethral closure pressure (MUCP) provides an objective assessment of urethral integrity, but its role in predicting outcome after midurethral sling (MUS) placement is debatable and current practice in the UK is variable. The study was carried out to determine if lower preoperative MUCP is associated with poor outcome following MUS.

Method

The study was a retrospective review of the British Society of Urogynaecology (BSUG) database and urodynamics (UDS) data. Patients who reported outcome as “no improvement”, “worse” or “much worse” on the Patient Global Impression of Improvement (PGII) scale were identified as having a poor outcome. Patients who reported “a little improvement”, “improved” and “very much improved” on the PGII were thought to have a good outcome. The preoperative demographics, UDS findings and quality of life (International Consultation of Incontinence questionnaires [ICIQ-SF]) data of the two groups were compared.

Result

A total of 236 women were identified for the study. Of these, 24 women (10.2 %) had a poor outcome. Of the remaining women reporting a good outcome, 50 cases were randomly selected. All urodynamic parameters, including mean functional urethral length (FUL), bladder capacity, and Qmax, were similar, except for mean MUCP 37.05 cm H₂O, which was significantly lower in group 1 (poor outcome 37.05 cm H₂O) compared with a mean MUCP of 50.6 cm H₂O in group 2 (good outcome; p = 0.005).

Conclusion

We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure.

Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C (2013) Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J 24(8):126CrossRef

Barber MD, Kleeman S, Karram MM et al (2008) Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Am J Obstet Gynecol 199:666.e1–666.e7CrossRef

Cammu H, Van Den Abbele E, Nagel H et al (2009) Factors predictive of outcome in tension-free vaginal tape procedure for urinary stress incontinence in a teaching hospital. Int Urogynecol J 20:775–780CrossRef

Stav K, Dwyer PL, Rosamilia A et al (2010) Risk factors of treatment failure of midurethral sling procedures for women with urinary stress incontinence. Int Urogynecol J 21:149–155CrossRefPubMed

Karateke A, Haliloglu B, Cam C et al (2009) Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study. Aust NZ J Obstet Gynaecol 49:99CrossRef

Houwert RM, Venema PL, Aquarius AE et al (2009) Risk factors for failure of retropubic and transobturator midurethral slings. Am J Obstet Gynecol 201(202):e201–e208

Costantini E, Lazzeri M, Giannantoni A, Bini V, del Zingaro M, Porena M (2009) Preoperative MUCP and VLPP did not predict long-term (4-year) outcome after transobturator mid-urethral sling. Urol Int 83(4):392–398CrossRefPubMed

Meschia M, Pifarotti P, Buonaguidi A et al (2005) Tension-free vaginal tape (TVT) for treatment of stress urinary incontinence in women with low-pressure urethra. Eur J Obstet Gynecol Reprod Biol 122:118CrossRefPubMed

Kawasaki A, Wu JM, Amundsen CL, Weidner AC, Judd JP, Balk EM, Siddiqui NY (2012) Do urodynamic parameters predict persistent postoperative stress incontinence after midurethral sling? A systematic review. Int Urogynecol J 23(7):813–822CrossRefPubMed

10.

Lose G, Griffiths D, Hosker G, Kulseng-Hanssen S, Perucchini D et al (2002) Standardisation of urethral pressure measurement: report from the standardisation subcommittee of the International Continence Society. Neurourol Urodyn 21:258–260CrossRefPubMed

11.

Constantinou CE (1988) Urethrometry: considerations of static, dynamic, and stability characteristics of the female urethra. Neurourol Urodyn 7:521–539CrossRef

12.

Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189:98–101CrossRefPubMed

13.

Ashok K, Wang A (2010) Recurrent urinary stress incontinence: an overview. J Obstet Gynaecol Res 36:467–473CrossRefPubMed

14.

Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, Kraus SR, Chai TC, Lemack GE, Dandreo KJ, Varner RE, Menefee S, Ghetti C, Brubaker L, Nygaard I, Khandwala S, Rozanski TA, Johnson H, Schaffer J, Stoddard AM, Holley RL, Nager CW, Moalli P, Mueller E, Arisco AM, Corton M, Tennstedt S, Chang TD, Gormley EA, Litman HJ (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362:2066–2076CrossRefPubMedPubMedCentral

15.

Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, Hilton P, Nilsson CG, Waltregny D (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 58:218–238CrossRefPubMed

16.

Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A, Hiscock R (2012) Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol 119(2 Pt 1):321–327CrossRefPubMed

17.

Duckett JR, Tamilselvi A (2006) Effect of tension-free vaginal tape in women with a urodynamic diagnosis of idiopathic detrusor overactivity and stress incontinence. BJOG 113:30CrossRefPubMed

18.

Laurikainen E, Kiilholma P (2003) The tension-free vaginal tape procedure for female urinary incontinence without preoperative urodynamic evaluation. J Am Coll Surg 196:579CrossRefPubMed

19.

Nager CW, Brubaker L, Litman HJ et al (2012) Urinary incontinence treatment network. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 366:1287–1297CrossRef

20.

Nager CW, Siris L, Litman HJ et al (2011) Baseline urodynamic predictors of treatment failure 1 year after midurethral sling surgery. J Urol 186:597–603CrossRefPubMed

21.

Jung HJ, Yim GW, Jeon MJ, Kim SK, Bai SW (2009) Preoperative maximum urethral closure pressure and valsalva leak point pressure as predictive parameters for midurethral sling. J Reprod Med 54(7):436–440PubMed

22.

Tomoe H (2013) Value of maximum urethral closure pressure in predicting the outcome of tension-free vaginal tape and transobturator tape procedure. LUTS: Lower Urinary Tract Symptoms 5(2):65–68PubMed

23.

Drahorádová P, Masata J, Martan A, Svabík K, Pavlíková M (2009) Can the preoperative value of VLPP and MUCP predict the postoperative quality of life? Prague Med Rep 110(1):42–50PubMed

24.

Harris N, Swithinbank L, Hayek SA, Yang Q, Abrams P (2011) Can maximum urethral closure pressure (MUCP) be used to predict outcome of surgical treatment of stress urinary incontinence? Neurourol Urodyn 30(8):1609–1612CrossRefPubMed

25.

Kang J, Gou X, Zhao QH, He WY, Xiao MZ, Wang M, Deng YZ (2013) Cough test during tension-free vaginal tape procedure in preventing postoperative urinary retention. Adv Urol 2013:797854CrossRefPubMedPubMedCentral

26.

Moore KH, Shahab RB, Walsh CA, Kuteesa WM, Sarma S, Cebola M, Allen W, Wang YA, Karantanis E (2012) Randomized controlled trial of cough test versus no cough test in the tension-free vaginal tape procedure: effect upon voiding dysfunction and 12 month efficacy. Int Urogynecol J 23(4):435–441CrossRefPubMed

Title: Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? A time to revisit
Authors: Monika Vij
Anupreet Dua
Robert M. Freeman
Publication date: 01-10-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 10/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-016-3007-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? A time to revisit

Abstract

Introduction and hypothesis

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Method

Result

Conclusion

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