title: Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure.
abstract: OBJECTIVE
  To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence.
  
  
  METHODS
  A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30° on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH2O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05.
  
  
  RESULTS
  Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates.
  
  
  CONCLUSIONS
  High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.
authors.affiliation: Department of Urology, Section of Urogynecology, Ipiranga Hospital, São Paulo, Brazil. luisgtoledo@uol.com.br
authors.forename: Luis Gustavo Morato de
authors.initials: LG
authors.lastname: Toledo
authors.forename: Pedro Henrique Oliveira
authors.initials: PH
authors.lastname: Cabral
authors.forename: Mário Luis
authors.initials: ML
authors.lastname: Casella
authors.forename: Gabriel Elias
authors.initials: GE
authors.lastname: Politi
authors.forename: Sandro Nasser
authors.initials: SN
authors.lastname: Cardoso
authors.forename: Luiz Figueiredo
authors.initials: LF
authors.lastname: Mello
authors.forename: Sidney
authors.initials: S
authors.lastname: Glina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D053825:Suburethral Slings; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014636:Valsalva Maneuver / Q000502:physiology*