title: Is transobturator tape as effective as tension-free vaginal tape in patients with borderline maximum urethral closure pressure?
abstract: BACKGROUND
  The purpose of this study was to compare transobturator tape (MONARC) with tension-free vaginal tape in patients with borderline low maximum urethral closure pressure.
  
  
  METHODS
  Historical cohort analysis of 3-month outcomes in 145 subjects (MONARC = 85; tension-free vaginal tape = 60). A cut-off point of 42 cm H2O for preoperative maximum urethral closure pressure was identified as predictor of success in the entire cohort. The cohort was stratified by sling type and analyzed. Outcome variables included urodynamic stress incontinence, urethral pressure profiles, subjective stress incontinence symptoms, and complications.
  
  
  RESULTS
  The relative risk of postoperative urodynamic stress incontinence 3 months after surgery in patients with a preoperative maximum urethral closure pressure of 42 cm or less H2O was 5.89 (1.02 to 33.90, 95% confidence interval) when we compared MONARC with tension-free vaginal tape. Subjects in the MONARC and tension-free vaginal tape groups did not differ significantly in baseline characteristics. We defined subjects as failures if they demonstrated postoperative objective stress incontinence on multichannel urodynamic testing.
  
  
  CONCLUSIONS
  In subjects with maximum urethral closure pressure of 42 cm or less H2O, the MONARC was nearly 6 times more likely to fail than tension-free vaginal tape at 3 months after surgery. Long-term follow-up and randomized controlled trials are needed.
authors.affiliation: Evanston Continence Center, Northwestern University, Feinberg School of Medicine, Evanston, IL, USA. jmiller3@enh.org
authors.forename: Jay-James R
authors.initials: JJ
authors.lastname: Miller
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: Botros
authors.forename: Mohamed N
authors.initials: MN
authors.lastname: Akl
authors.forename: Sarit O
authors.initials: SO
authors.lastname: Aschkenazi
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.forename: Roger P
authors.initials: RP
authors.lastname: Goldberg
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sand
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D011184:Postoperative Period; D011312:Pressure; D012306:Risk; D053832:Surgical Tape / Q000009:adverse effects; D014521:Urethra / Q000503:physiopathology; D014522:Urethral Diseases / Q000503:physiopathology* / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014621:Vagina