Reliability and correlation of measurements during and after bladder neck surgery. The Continence Program for Women Research Group.
OBJECTIVE
To assess the reliability of seven intraoperative measurements of the effects of bladder neck suspension and correlate these measurements with postoperative dynamic urethral obstruction, quantified as the cough-pressure transmission ratio.


METHODS
Sixty women undergoing surgery for bladder neck hypermobility had seven measurements performed in duplicate: (i) the endoscopic appearance of the bladder neck: (ii) the bladder neck-retropubic surface distance (BN-RP distance); (iii) urethral axis; (iv) slow urethral pressure profilometry (UPP); (v) fast UPP; (vi) straining UPP; and (vii) dynamic UPP. Reliabilities were assessed by computing the intraclass correlation coefficient (R) for continuous data or Kappa statistic (K) for ordinal data. Pearson correlation coefficients were used to assess the relationships between the intra-operative measures and postoperative pressure transmission.


RESULTS
The intra-operative reliabilities for maximum pressure, length and area from the three UPP techniques were high (R=0.88-0.98) as were those for urethral axis measurements (R=0.98). In contrast, reliabilities were poor for pressure transmission ratios (R=0.15-0.33), BN-RP distance (R=0.55), and endoscopic appearance (K=0.10). There were significant correlations of the pressures from the UPPs and intra-operative pressure transmission ratios with postoperative pressure transmission ratios; however, the poor intra-operative reliability of intra-operative pressure transmission limits their usefulness. None of the other measures correlated significantly with postoperative pressure transmission ratios.


CONCLUSIONS
Of the measures studied, only intra-operative UPPs had both high reliability and good postoperative correlations.
Bump
R C
RC
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Hurt
W G
WG
Addison
W A
WA
Fantl
J A
JA
McClish
D K
DK
D000368:Aged; D003558:Cystoscopy / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015588:Observer Variation; D010388:Pelvis; D011182:Postoperative Care; D011312:Pressure; D011391:Prolapse; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D014524:Urethral Obstruction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery