Preoperative maximum urethral closure pressure and valsalva leak point pressure as predictive parameters for midurethral sling

Hyun Joo Jung, Ga Won Yim, Myung Jae Jeon, Sei Kwang Kim, Sang Wook Bai
Journal of Reproductive Medicine 2009, 54 (7): 436-40

OBJECTIVE: To evaluate the efficacy of tension-free vaginal tape (TVT) and transobturator tape (TOT) according to urethral function based on a preoperative urodynamic study (UDS).

STUDY DESIGN: Preoperative Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP) were compared with the actual surgical outcome, and patients were followed for > 1 year. Student's t test, chi2 test, multiple regression analysis and receiver operating character curve analysis were used for statistical analysis. Of the 437 patients, 225 received TVT and 212 patients received TOT.

RESULTS: Age, parity, body mass index, menopausal status, hormone replacement therapy and previous surgical history showed no significant difference between the groups. Advanced pelvic organ prolapse, concomitant hysterectomy and vault suspension were more common in the TOT group, whereas concomitant anterior colporrhaphy was more common in the TVT group. The treatment outcome of TVT was not associated with VLPP and MUCP. However, cutoff values of VLPP > or = 72.5 cm H2O and MUPC > or = 42 cm H2O were most predictive of successful surgical outcomes in TOT group, revealing a sensitivity of 95.7% and a positive predictive value of 98.4%.

CONCLUSION: Preoperative MUCP and VLPP can predict the treatment outcome of TOT but not TVT.

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