title: Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence.
abstract: OBJECTIVE
  To determine if specific pre-operative urodynamic parameters could predict detrusor overactivity following TVT in patients with urodynamic mixed incontinence.
  
  
  METHODS
  Notes of women with detrusor overactivity (DO) and urodynamic stress incontinence (USI) before undergoing tension-free vaginal tape (TVT) surgery were retrospectively reviewed. Patients underwent clinical evaluation pre-operatively including history, examination, and conventional urodynamic studies and were treated with pelvic floor exercises and anti-cholinergic medication. Those with persistent stress urinary incontinence (SUI) underwent TVT. Patients were re-assessed after at least 6 months post-operatively. Pre- and post-operative opening and closing detrusor pressure, and detrusor pressure at maximum flow were recorded retrospectively from pre-operative urodynamics traces by two clinicians independently and compared to the patients' post-operative symptoms and urodynamic diagnosis.
  
  
  RESULTS
  Fifty-one women were reviewed. Forty-six of the 51 attended follow-up and 35/51 agreed to conventional urodynamic studies. Seventeen of the 35 reported OAB symptoms, and 18/35 were asymptomatic. Nineteen of the 35 women had DO and 16/35 had normal urodynamic studies (NUDS). The median pre-operative opening detrusor pressure was higher in women with overactive bladder symptoms post-operatively. The median pre-operative opening detrusor pressure in women with DO post-operatively was 33.0 cmH(2)O and the median pre-operative opening detrusor pressure in those with NUDS post-operatively was 16 cmH(2)O (15.0-23.0 cmH(2)O) (P < 0.05 Mann-Whitney U-test).
  
  
  CONCLUSIONS
  Higher numbers of patients are required to demonstrate the value of opening detrusor pressure in predicting post-operative overactive bladder symptoms. Opening detrusor pressure is predictive of post-operative DO after TVT.
authors.affiliation: Department of Urogynaecology, St. Mary's Hospital, London, United Kingdom. drpanayi@gmail.com
authors.forename: D C
authors.initials: DC
authors.lastname: Panayi
authors.forename: J
authors.initials: J
authors.lastname: Duckett
authors.forename: G A
authors.initials: GA
authors.lastname: Digesu
authors.forename: M
authors.initials: M
authors.lastname: Camarata
authors.forename: M
authors.initials: M
authors.lastname: Basu
authors.forename: V
authors.initials: V
authors.lastname: Khullar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D011312:Pressure; D012189:Retrospective Studies; D053825:Suburethral Slings; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000295:instrumentation*
chemical_list: D018680:Cholinergic Antagonists