title: Value of Maximum Urethral Closure Pressure in Predicting the Outcome of Tension-Free Vaginal Tape and Transobturator Tape Procedure.
abstract: OBJECTIVE
  The short-term results for the tension-free vaginal tape procedure (TVT) and the transobturator tape procedure (TOT) for stress urinary incontinence (SUI) were compared using the preoperative maximum urethral closure pressure (MUCP).
  
  
  METHODS
  A total of 278 patients treated for SUI was considered: 165 who underwent TVT and 113 who underwent TOT retrospectively. The MUCP in a preoperative urodynamic study before and 3 months after surgery were evaluated.
  
  
  RESULTS
  At 3 months after TVT, 159 patients (96.4%) were cured and four patients failed. The mean MUCP of the patients who failed was 22.5 ± 5.3 cmH2 O, which was significantly lower than that among the cured patients (P < 0.007). At 3 months after TOT, 100 patients (88.5%) were cured and seven patients failed. The mean MUCP of the patients who failed was 27 ± 6.3 cmH2 O, which was significantly lower than that among the cured patients (P < 0.001). Furthermore, the mean MUCP among the patients who were cured after TOT was significantly higher than that among the patients who were cured after TVT (P < 0.01). A further analysis using a ROC curve indicated that the MUCP value in the successful patients after TVT was ≧ 24 cmH2 O and that in the failures after TOT was ≦ 30 cmH2 O with selection sensitivity at 80%.
  
  
  CONCLUSIONS
  These results suggest that the failure cases after TVT or TOT are often found in SUI with a low MUCP and that TVT might be superior to TOT in SUI with a MUCP ≦ 30 cmH2 O.
authors.affiliation: Department of Urology and Pelvic Reconstructive Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Tomoe
keywords: intrinsic urethral sphincter deficiency; maximum urethral closure pressure; stress urinary incontinence; tension-free vaginal tape; transobturator tape