Preoperative maximum urethral closure pressure and valsalva leak point pressure as predictive parameters for midurethral sling.
OBJECTIVE
To evaluate the efficacy of tension-free vaginal tape (TVT) and transobturator tape (TOT) according to urethral function based on a preoperative urodynamic study (UDS).


METHODS
Preoperative Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP) were compared with the actual surgical outcome, and patients were followed for > 1 year. Student's t test, chi2 test, multiple regression analysis and receiver operating character curve analysis were used for statistical analysis. Of the 437 patients, 225 received TVT and 212 patients received TOT.


RESULTS
Age, parity, body mass index, menopausal status, hormone replacement therapy and previous surgical history showed no significant difference between the groups. Advanced pelvic organ prolapse, concomitant hysterectomy and vault suspension were more common in the TOT group, whereas concomitant anterior colporrhaphy was more common in the TVT group. The treatment outcome of TVT was not associated with VLPP and MUCP. However, cutoff values of VLPP > or = 72.5 cm H2O and MUPC > or = 42 cm H2O were most predictive of successful surgical outcomes in TOT group, revealing a sensitivity of 95.7% and a positive predictive value of 98.4%.


CONCLUSIONS
Preoperative MUCP and VLPP can predict the treatment outcome of TOT but not TVT.
Jung
Hyun Joo
HJ
Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, South Korea.
Yim
Ga Won
GW
Jeon
Myung Jae
MJ
Kim
Sei Kwang
SK
Bai
Sang Wook
SW
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D008875:Middle Aged; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012372:ROC Curve; D012016:Reference Values; D053825:Suburethral Slings; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics