title: A Valsalva leak-point pressure of >100 cmH2O is associated with greater success in AdVance™ sling placement for the treatment of post-prostatectomy urinary incontinence.
abstract: OBJECTIVE
  To determine if there is a Valsalva leak-point pressure (VLPP) threshold that predicts for retro-urethral transobturator sling (RTS) success in men with post-prostatectomy urinary incontinence (UI).
  
  
  METHODS
  The preoperative urodynamic parameters of all patients undergoing RTS (AdVance™) sling surgery over the last 5 years were analysed and compared with the postoperative outcomes. The sling was defined as having been successful if the patient no longer had to wear pads or merely used a pad to provide a sense of security.
  
  
  RESULTS
  In all, 46 men with a mean (range) age of 65 (45-83) years, underwent AdVance™ sling surgery. 10 men had undergone holmium laser enucleation of the prostate, one a transurethral resection of the prostate and 35 radical prostatectomy. 11 men had a VLPP of ≤100 cmH2O. Of these 11 men, three had no, or minimal, improvement in their leakage and all three required a secondary procedure (artificial urinary sphincter, AUS). In the 35 men with a VLPP of >100 cmH2O there were three failures. One of these was successfully salvaged with a repeat sling, another with an AUS and one with ProACT™ balloons. The hazard ratio (HR) for failure with a VLPP of ≤100 cmH20 compared with a VLPP of >100 cmH2O was 4 (95% confidence interval 0.68-23.7).
  
  
  CONCLUSIONS
  A VLPP of >100 cmH2O has a high degree of predictability for success for AdVance™ sling placement for men with post-prostatectomy UI.
authors.affiliation: Department of Urology, Auckland Hospital, Auckland, New Zealand.
authors.forename: Jon
authors.initials: J
authors.lastname: Barnard
authors.forename: Simon
authors.initials: S
authors.lastname: van Rij
authors.forename: Andre M
authors.initials: AM
authors.lastname: Westenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011468:Prostatectomy / Q000009:adverse effects; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology*; D014636:Valsalva Maneuver / Q000502:physiology*
keywords: AdVance sling surgery; Valsalva leak-point pressure; post-prostatectomy urinary incontinence; retro-urethral sling surgery; video-urodynamics