Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure

Abstract

ARTICLE INFO _________________________________________________________ ___________________Purpose: To analyze the influence of urethral mobility and Valsalva leak point pressure on postoperative outcomes of transobturator sling (TOT) for female stress urinary incontinence. Materials and Methods: A prospective cohort was conducted including 66 patients submitted to TOT from March 2006 to May 2009. Urethral hypermobility was defined as mobility ≥ 30º on Q-tip test, and Valsalva leak point pressure (VLPP) was classified as greater than 60 cmH 2 O or 60 and less on preoperative urodynamics. These parameters were compared through well defined postoperative objective and subjective success criteria. Intensity of urinary leakage and quality of life was analysed by ICIQ-SF. Statistical analysis was accomplished and the results rendered significant if p < 0.05. Results: Mean follow up was 10 months (3 to 28). Mean age was 55 years (33 to 80), 70% were white and 30% African descendent, mean body mass index was 27 (21 to 38), average vaginal and abdominal deliveries were 2.8 and 0.5 respectively. A quarter had prior stress incontinence surgery. Patients with urethral hypermobility had higher objective success rates (98% versus 81.25%, p = 0.04). The subjective success rate was also greater in the hypermobility group (84% versus 62.5%), but statistical significance was not reached (p = 0.07). VLPP had no influence on either objective or subjective postoperative success rates (p = 0.17 and 0.34, respectively). In the subgroup analysis, those with low mobility and high VLPP had worse objective success rates in comparison to the group with hypermobility and low VLPP (p = 0.04) and also in relation to the remaining of the studied population. Other possible prognostic factors (previous surgery, mixed incontinence, gestational status) had no influence on success rates. Conclusions: High urethral mobility, regardless of the sphincteric status indicated by VLPP, is a favorable prognostic factor for tension-free transobturator tape procedure. No relationship was demonstrated between postoperative success rates and VLPP.

Do different vaginal tapes need different suburethral incisions? The one-half rule

“…Similar to earlier studies, we found that urethral mobility plays an important role in surgical outcomes following vaginal tape insertion procedures . For women with a hypermobile urethra—one of the main indications for treatment with a TOT—the likelihood of success is generally high.…”

“…Our findings show that when inserting a TOT, beginning the incision at 1/2 the urethral length was more likely to result in a successful outcome than at 1/3 of the urethral length—similar to the standard technique for classical retropubic TVT . One important conclusion of this study, which is consistent with earlier studies, is that patient characteristics (i.e., urethral mobility) ought to be assessed and appropriately matched with the particular functionality of the tapes …”

“…However, Ulmsten's technique was originally developed using technology available over two decades ago that involved radiomorphologic and urodynamic studies. Recent studies utilizing advanced, dynamic medical technology (i.e., 3D/4D ultrasound) found that variations in anatomical/physiological characteristics of women (i.e., urethral length, height of the vaginal sulci, and mobility of the urethra) influence the success of the SUI outcome and the occurrence of postoperative complications …”

Influence of age, menopause, pelvic muscle exercises, urethral hypermobility and concomitant surgery on the outcomes after the transobturator tape procedure (factors effecting TOT outcomes)

“…A small number of patients in our study is thought to have prevented the net effect of menopausal status on the outcomes after the TOT procedure to become apparent. There are reports indicating that advanced age could negatively affect the success rate of the TOT procedure [23,24]. In contrast, de Toledo et al reported that patient age did not affect the outcomes of the TOT procedure [24].…”

“…There are reports indicating that advanced age could negatively affect the success rate of the TOT procedure [23,24]. In contrast, de Toledo et al reported that patient age did not affect the outcomes of the TOT procedure [24]. In our study, we did not find any difference between patients below and at or above 50 years of age in terms of treatment success and complication rates, a finding which is in conformity with that in the study by de Toledo et al (p = 0.351 and p = 1.000, respectively).…”