Evaluation of per-operative cough stress test during transobturator mid-urethral sling surgery

Abstract

This study has been presented in EAU 2015 Meeting in Madrid.Purpose: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT. Materials and methods: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level. At the end of 1st year, two groups were compared patient characteristics, operation time, duration of hospital stay, cure and complication rates. Results: The cure rate was 84.37% 81/96) versus 83.63% (92/110) in TOT and TOT with cough test groups, respectively. Postoperatively ten patient (10/110, 9.09%) suffered voiding difficulties (> 250 ml residual urine) in TOT with cough stress test group. Five patients were discharged with transurethral catheter, whereas, in traditional TOT group, two patients (2/96, 2.1%) had transient postoperative voiding difficulty and two patients were treated with repeated catheterization for 1 week (p < 0.05). Postoperative groin pain was present in 7/96 (8%) versus 24/110 (22%) in TOT and TOT with cough test groups, respectively (p < 0.05). TOT with cough stress test group had an higher rate of complications like, retention of urine, necessitating to cut the tape, mesh erosion and pain in groin or leg. No patient had resistant voiding difficulty or prolonged urinary retention (> 1 week) in traditional TOT group. Conclusions: We believe that per-operative cough stress test leads to overtreatment of stress urinary incontinence when the complication rates were considered. KEY WORDS: Cough stress test; Transobturator tape; Stress urinary incontinence (SUI). time and hospitalisation time, TOT has a high success rate up to 90% with lower complication rate (6-7). Although TOT is a safe and favorable for surgery for SUI, success of procedure is related with age, body mass index (BMI), diabetes mellitus, intrinsic sphincter deficiency and concomitant prolapsus surgery (8-9). Also urodynamic parameters including Q max , maximum urethral closure pressure and Valsalva leak point pressure have effects on operation success (10). Additionally, achieve adequate mesh tension is the one of most important point to prevent urinary incontinence. For assessment of the mesh tension, cough stress test (CST) is used intreoperatively while TOT procedure (11). As less tension is associated with leaving the patient incontinent, more tension may cause voiding disorders (12). In this study, we evaluated affect of CST on TOT procedure success rate and patients quality of life with using the Incontinence Impact Questionnaire and Urinary Distress Inventory Questionnaire. Also we assessed the effect of the adjustment of mesh tension with using CST on postoperative voiding disorders.

Active Compared With Passive Voiding Trials After Midurethral Sling Surgery

“…Ten active trial of void studies [10][11][12][16][17][18][19][20][21][22] with 1,370 patients and 16 passive trial of void studies [13][14][15][23][24][25][26][27][28][29][30][31][32][33][34][35] with 3,643 patients met inclusion criteria for passing the postoperative trial of void. Patients in the active group were significantly less likely to pass their postoperative trial of void (81%, 95% CI, 0.76-0.87% vs 89%, 95% CI, 0.84-0.93%, P5.029) with high heterogeneity (I 2 593.0%; Fig.…”

Húgycső alatti feszülésmentes szalagműtétek szerepe a nem komplikált női terheléses inkontinentia kezelésében Roles of mid-urethral sling procedures in the management of uncomplicated female stress urinary incontinence

“…TOT esetén RCT során vizsgálták az intraoperatív köhögtetésteszt eredményességét a szalagfeszesség beállítása tekintetében. Akiknél az intraoperatív teszt alapján végezték a szalagfeszesség beállítását, azoknál gyakoribb volt a korai posztoperatív vizelési nehezítettség (10 vs. 2%), és a lágyéki fájdalom (10 vs. 2%), ellenben nem találtak előnyt a terápiás siker mértékében (37). Összefüggés látható a műtét hatásossága és az azt végző operatőr műtéti volumene között.…”

Effect of anogenital distance on stress urinary incontinence

“…Incidence of SUI is very high in female population and Jha et al demonstrated that quarter of women experienced with life quality deterioration due to SUI in their lifespan [2]. Factors affecting on SUI are still under investigation and previous reports tried to identify reasons for SUI including age, body mass index (BMI), number of births, previous gynecological surgery history, and perineal anatomic properties [3].…”