title: Role of bladder neck mobility and urethral closure pressure in predicting outcome of tension-free vaginal tape (TVT) procedure.
abstract: OBJECTIVE
  To investigate how urethral mobility and urethral closure pressure affect the outcome of tension-free vaginal tape (TVT) insertion for stress incontinence.
  
  
  METHODS
  A total of 191 consecutive women with genuine stress urinary incontinence with or without intrinsic sphincter deficiency were evaluated prospectively with multichannel urodynamics, 24-h voiding diaries, clinical stress tests and introital ultrasound measurements preoperatively and 6 months after surgery. Additional introital ultrasound examinations were performed immediately after the operation, at 12 months and annually thereafter. 177/191 patients had completed a 36-month follow-up at the time of writing. Urethral mobility was described as linear dorsocaudal movement (LDM), with hypermobility being defined as LDM > 15 mm on sonography. Intrinsic sphincter deficiency was defined by a maximum urethral closure pressure (MUCP) of <20 cm H(2)O.
  
  
  RESULTS
  The overall cure rate at the 36-month follow-up was 89.5% (Kaplan-Meier estimator), with secondary cure (within 6 months of surgery) in 10.5% of these patients. The operation failed in 4.2% of the women and recurrence was seen in 6.3% of the cases. Bladder neck mobility was significantly reduced at the 6-month follow-up (P < 0.001). Compared with primary cure, therapeutic failure and secondary cure were associated with a significantly lower postoperative bladder neck mobility (P < 0.05). Postoperative hypermobility reduced the risk of therapeutic failure. In addition, women with therapeutic failure or secondary cure had a significantly lower MUCP than did those with primary cure (P < 0.01).
  
  
  CONCLUSIONS
  The effectiveness of the TVT sling appears to depend on adequate postoperative urethral mobility and urethral closure pressure.
authors.affiliation: Department of Gynecology and Obstetrics, Georg August University, Goettingen, Germany. volker.viereck@stgag.ch
authors.forename: V
authors.initials: V
authors.lastname: Viereck
authors.forename: M
authors.initials: M
authors.lastname: Nebel
authors.forename: W
authors.initials: W
authors.lastname: Bader
authors.forename: L
authors.initials: L
authors.lastname: Harms
authors.forename: R
authors.initials: R
authors.lastname: Lange
authors.forename: R
authors.initials: R
authors.lastname: Hilgers
authors.forename: G
authors.initials: G
authors.lastname: Emons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014463:Ultrasonography; D014522:Urethral Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery