Opening detrusor pressure and the influence of age on success following colposuspension.
OBJECTIVE
Women with urodynamic stress incontinence (USI) have lower opening and closing detrusor pressures than women without USI. This study was undertaken to determine whether a change occurs in opening and closing detrusor pressures after colposuspension, whether cure is associated with change, and whether age influences cure.


METHODS
Retrospective cohort study.


METHODS
Tertiary referral urogynaecology department.


METHODS
Consecutive women who had undergone colposuspension between 1998-2000 and 1993-1995.


METHODS
Pre- and post-operative urodynamic records were reviewed. Eighty eight women were included. Objective cure was defined as an absence of USI and subjective cure as an absence of symptoms of stress incontinence.


RESULTS
Mean age was 52.4 (11.0) years. Sixty nine percent (61/88) were objectively cured and 48% (42/88) were subjectively cured. Postoperatively, opening detrusor pressure increased (P = 0.0001) and maximum flow rate decreased (P= 0.0464) in women objectively cured but these parameters did not change in the not cured group (P > 0.05). Women had a 4.5 times higher chance of failed surgery if post-op opening detrusor pressure was < or =20 cmH2O (P = 0.035). Opening detrusor pressure declined with age (P < 0.001) and women who were objectively cured were on average almost 7 years younger (P = 0.0330).


CONCLUSIONS
Increase in opening detrusor pressure occurs only in women who are cured following colposuspension. Change in opening detrusor pressure is dependent on age and objective cure is higher in younger women. The effects of ageing on sub-urethral supports might explain why surgery is more likely to fail in older women.
Dolan
Lucia M
LM
The Warrell Unit, Saint Mary's Hospital, Whitworth Park, Manchester M13 OJH, United Kingdom. Dolanlm@aol.com
Smith
Anthony R B
AR
Hosker
Gordon L
GL
D000328:Adult; D000375:Aging; D015331:Cohort Studies; D004231:Diuresis; D005260:Female; D006801:Humans; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology* / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*; D014563:Urodynamics