title: Urodynamic changes associated with successful stress urinary incontinence surgery: is a little tension a good thing?
abstract: OBJECTIVE
  To identify urodynamic changes that correlate with successful outcomes after stress urinary incontinence (SUI) surgery.
  
  
  METHODS
  Six-hundred fifty-five women were randomized to Burch colposuspension or autologous fascial sling as part of the multicenter Stress Incontinence Surgical Treatment Efficacy Trial. Preoperatively and 24 months after surgery, participants underwent standardized urodynamic testing that included noninvasive uroflowmetry, cystometrogram, and pressure flow studies. Changes in urodynamic parameters were correlated to a successful outcome, defined a priori as (1) negative pad test; (2) no urinary incontinence on 3-day diary; (3) negative cough and Valsalva stress test; (4) no self-reported SUI symptoms on the Medical, Epidemiologic and Social Aspects of Aging Questionnaire; and (5) no re-treatment for SUI.
  
  
  RESULTS
  Subjects who met criteria for surgical success showed a greater relative increase in mean Pdet@Qmax (baseline vs 24 months) than women who were considered surgical failures (P = .008). Although a trend suggested an association between greater increases in bladder outlet obstruction index and outcome success, this was not statistically significant. Other urodynamic variables, such as maximum uroflow, bladder compliance, and the presence of preoperative or de novo detrusor overactivity did not differ with respect to outcome status.
  
  
  CONCLUSIONS
  Successful outcomes in both surgical groups (Burch and sling) were associated with higher voiding pressures relative to preoperative baseline values. However, concomitant changes in other urodynamic voiding parameters were not significantly associated with outcome.
authors: Department of Urology, University of Texas Health Sciences Center, San Antonio, TX 78229-3900, USA. Krauss@uthscsa.edu
authors: Stephen R
authors: SR
authors: Kraus
authors: Gary E
authors: GE
authors: Lemack
authors: Larry T
authors: LT
authors: Sirls
authors: Toby C
authors: TC
authors: Chai
authors: Linda
authors: L
authors: Brubaker
authors: Michael
authors: M
authors: Albo
authors: Wendy W
authors: WW
authors: Leng
authors: L Keith
authors: LK
authors: Lloyd
authors: Peggy
authors: P
authors: Norton
authors: Heather J
authors: HJ
authors: Litman
mesh_terms: D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology*; D011312:Pressure; D012212:Rheology; D053825:Suburethral Slings / Q000009:adverse effects; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014554:Urination; D014563:Urodynamics