Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings: analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

Abstract

Objective: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of midurethra slings for female stress urinary incontinence (SUI). Materials and Methods: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Results: Mean follow-ups were 32 ± 12 months (range 12-55) for TVT and 31 ± 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H 2 O and 50 (34.5%) patients had a VLPP ≤ 60 cm H 2 O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H 2 O and 72% for those with VLPP ≤ 60 cm H 2 O (p < 0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H 2 O (82 % vs. 68.9% p < 0.172); VLPP ≤ 60 cm H 2 O (68% vs. 76% p < 0.528). Conclusions: When patients were stratified for preoperative VLPP (≤ or > of 60 cm H 2 O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.

A Comparison of the Clinical Efficacy of the Transobturator Adjustable Tape (TOA) and Transobturator Tape (TOT) for Treating Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency: Short-term Results

“…In one study, Hsiou et al [17] retrospectively analyzed 61 cases of TVT and 60 cases of TOT and found that low MUCP (< 40 cmH 2 O) was an independent risk factor for sling failure for the TOT group but not the TVT group. On the contrary, in ancillary studies from two separate RCTs comparing TVT with TOT [11,18], no significant differences in objective stress incontinence cure rates in ISD cases based on a VLPP of 60 cmH 2 O or less were reported. Surgical failure occurred in 8 of 25 patients (32%) in the TOT group compared with 6 (24%) of 25 patients in the TVT group (p>0.05).…”

“…TOT has been used for the treatment of SUI patients along with TVT, but there have been only a few reports on its outcomes for SUI with ISD. Costantini et al [11] reported that the cure rate of the TOT procedure was 77.3% in women with ISD.…”

Mid-urethral slings in female incontinence: Current status

“…Although the numbers are small, when subanalysis was performed there was no difference in cure rates between TVT and TOT [76% vs 68%, respectively ( P =0.528)]. [27] On the contrary, another randomized study demonstrated equal efficacy between TVT and TOT in 145 patients with ISD. Of the entire cohort, 50 women (34.5%) had a VLPP <60 cm H 2 O.…”

What is the best indication for single-incision Ophira Mini Sling? Insights from a 2-year follow-up international multicentric study

“…In 2001, Delorme developed the transobturator tape (TOT) technique [5] to reduce perioperative complications related to the blind passage of needles in the retropubic space. Several studies reported high cure and low complication rates for TOT and, based on preoperative urodynamic findings and postoperative clinical examination, uroflowmetry, and cough test, the authors discussed the mechanisms responsible for the success of this treatment [6, 7]. Continence rate with the transobturator approach is reportedly similar to that obtained with the transvaginal retropubic approach [6, 7].…”

“…Several studies reported high cure and low complication rates for TOT and, based on preoperative urodynamic findings and postoperative clinical examination, uroflowmetry, and cough test, the authors discussed the mechanisms responsible for the success of this treatment [6, 7]. Continence rate with the transobturator approach is reportedly similar to that obtained with the transvaginal retropubic approach [6, 7]. Most of the described complications of retropubic slings are related to the blind nature of these procedures [8].…”