Low valsalva leak-point pressure and success of retropubic urethropexy.
The aim of this study was to determine whether an isolated low Valsalva leak-point pressure (VLPP) is predictive of intrinsic sphincter deficiency (ISD) and can be an independent risk factor for retropubic urethropexy failure in patients with a normal maximal urethral closure pressure (MUCP). Twenty-four women with urodynamically proven genuine stress incontinence with low VLPP (<60 cmH2O) and normal MUCP (>20 cmH2O) were evaluated subjectively and objectively by complex urodynamic testing before and after undergoing a modified Burch urethropexy. Success rates were then compared to historical success rates for subjects with ISD treated with retropubic urethropexy using an exact one-sample test for binomial proportions. Patients were followed postoperatively for a mean of 11.1 months, with a range of 5-16 months. Twenty-two of the 24 (91.7%) were continent on postoperative cystometry. This differs significantly from the published success rates of 50% (P < 0.001), if a low VLPP alone were predictive of ISD. Retropubic urethropexy was successful in the majority of our patients with genuine stress incontinence with a low VLPP and normal MUCP.
Hsieh
G C
GC
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033, USA. Jeffhmd@aol.com
Klutke
J J
JJ
Kobak
W H
WH
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014521:Urethra / Q000473:pathology* / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000473:pathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*