title: Outcome of TVT operations in women with low maximum urethral closure pressure.
abstract: OBJECTIVE
  (i) To establish whether low maximal urethral closure pressure (MUCP) is associated with a poorer prognosis after TVT-surgery, and if so to establish an MUCP cut-off value for poor outcome. (ii) To characterize the population with a low MUCP.
  
  
  METHODS
  Retrospective analysis of data from 6,646 women with stress/mixed urinary incontinence included in the Norwegian Female Incontinence Registry. Postoperative subjective (degree of satisfaction), objective (leakage on stress test) and composite cure according to preoperative MUCP were analyzed in unadjusted and adjusted analysis. Preoperative variables were compared between women having a low or normal MUCP. Non-parametric tests were used on continuous variables and χ2tests on categorical variables. Logistic regression was used for the adjusted analysis. Level of significance: P < 0.05.
  
  
  RESULTS
  An analysis of centiles of preoperative MUCP showed that a cut-off at 20 cm H2O did best identify women at risk of not being cured. In unadjusted analysis MUCP ≤20 cm H2O (n = 422) was associated with objective (OR: 2.48), subjective (OR: 1.60), and composite failure (OR: 1.95) compared to MUCP >20 cm H2O. In adjusted analysis MUCP ≤20 cm H2O was associated with neither objective, subjective, nor composite failure. Women with MUCP <20 cm H2O were preoperatively significantly older, had larger leakage on stress and 24 h pad test, lower mean voided volume and maximum flow rate and higher stress and urge indices.
  
  
  CONCLUSIONS
  Women with MUCP ≤20 cm H2O have similar objective, subjective, and composite outcomes after TVT-surgery compared to women with MUCP >20 cm H2O after adjusting for preoperative variables. Neurourol. Urodynam. 36:1320-1324, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Kjartan
authors.initials: K
authors.lastname: Moe
authors.affiliation: Department of Obstetrics and Gynecology, Vestfold Hospital, Tønsberg, Norway.
authors.forename: Hjalmar A
authors.initials: HA
authors.lastname: Schiøtz
authors.affiliation: Department of Obstetrics and Gynecology, Baerum Hospital, Rud, Norway.
authors.forename: Sigurd
authors.initials: S
authors.lastname: Kulseng-Hanssen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology
keywords: maximal urethral closure pressure prevalence; midurethral sling; prognosis; urinary incontinence