title: Urodynamic parameters after retrourethral transobturator male sling and their influence on outcome.
abstract: OBJECTIVE
  To evaluate prospectively detailed urodynamic parameters before and after retrourethral transobturator sling (RTS) placement and the impact of adverse preoperative urodynamic parameters on postoperative outcome.
  
  
  METHODS
  Fifty-five consecutive patients with postprostatectomy stress urinary incontinence (SUI) underwent urodynamics with pressure flow and abdominal leak point pressure (ALPP) measurements, quality of life, 1-hour pad test, and daily pad use assessment before RTS (AdVance) and 12 months postoperatively. Volume of first sensation and first desire to void, maximum cystometric capacity (MCC), ALPP, maximum flow rate (Qmax.), average flow rate, time to Qmax., detrusor voiding pressure at Qmax., voiding time, and postvoid residual urine volume (PVR) were assessed. The success rate was defined as cure (no or one dry "security" pad) or improvement (1-2 pads or pad reduction≥50%). Adverse parameters included ALPP≤30 cm H2O, Qmax.≤10 mdL/s, and MCC≤200 mL.
  
  
  RESULTS
  Success rate after RTS was 73% (40/55 patients). Mean follow-up was 21±11.7 (range, 12-41) months. Only ALPP changed significantly (61±14.2 vs 79±20.4 cm H2O). No PVR>30 mL, de novo reduced bladder compliance and hypo- or overactivity were observed. Urine loss by 1-hour pad test (136.1±119.4 vs 39.4±77.0) and daily pad use (4.6±2.0 vs 1.9±2.1) decreased significantly. Adverse preoperative urodynamic parameters were not associated with postoperative outcome.
  
  
  CONCLUSIONS
  The RTS is an effective and safe device for SUI treatment without signs of compression or obstruction of the urethra or any influence on voiding parameters. Adverse preoperative urodynamic parameters have no influence on postoperative outcome.
authors.affiliation: Department of Urology, Klinikum Grosshadern, Ludwig-Maximilian-University Munich, Germany. Irina.Soljanik@med.uni.muenchen.de
authors.forename: Irina
authors.initials: I
authors.lastname: Soljanik
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Becker
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Christian
authors.initials: C
authors.lastname: Gozzi
authors.forename: Ricarda M
authors.initials: RM
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011788:Quality of Life; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics