Preoperative MUCP and VLPP did not predict long-term (4-year) outcome after transobturator mid-urethral sling

Elisabetta Costantini, Massimo Lazzeri, Antonella Giannantoni, Vittorio Bini, Michele del Zingaro, Massimo Porena
Urologia Internationalis 2009, 83 (4): 392-8

OBJECTIVE: Maximum urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP) have been considered objective parameters for studying the urethral integrity and predicting outcome after surgery for stress urinary incontinence (SUI). We test the hypothesis that preoperative MUCP and/or VLPP may predict long-term outcome after out-in transobturator tape (TOT) surgery for female SUI.

METHODS: 65 patients affected by stress or mixed urinary incontinence were enrolled in a prospective observational descriptive study conducted from May 2002 to November 2005 at a single tertiary urban teaching university urogynecological department. Preoperative MUCP and VLPP, stratified as < or = or >40 cm H(2)O and < or = or >60 cm H(2)O, respectively, were separately or in combination correlated with primary (continence status: dry or wet) and secondary outcome variables (quality of life questionnaires) after surgery.

RESULTS: Out of 65 patients, 6 (9.2%) did not attend the follow-up. The median follow-up was 46 months (mean 52 +/- 18; range 36-82). The overall objective cure rates (dry) were 74.4% for patients with VLPP >60 cm H(2)O and 65% for VLPP < or =60 cm H(2)O (p < 0.654). The overall objective cure rates (dry) were 75% for patients with MUCP >40 cm H(2)O and 68.6% for MUCP < or =40 cm H(2)O (p < 0.808). The overall objective cure rates (dry) were 82.4% for patients with MUCP >40 cm H(2)O and VLPP >60 cm H(2)O and 69.2% for MUCP < or =40 cm H(2)O and VLPP < or =60 cm H(2)O (p < 0.956).

CONCLUSIONS: These data seem to cast doubts on the predictive value of MUCP and VLPP in patients who underwent TOT.

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