Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure
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...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Urologia
2012-10-01
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| Series: | International Brazilian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382012000500012 |
| _version_ | 1818966733929578496 |
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| author | Luis Gustavo Morato de Toledo Pedro Henrique Oliveira Cabral Mário Luís Casella Gabriel Elias Politi Sandro Nasser Cardoso Luiz Figueiredo Mello Sidney Glina |
| author_facet | Luis Gustavo Morato de Toledo Pedro Henrique Oliveira Cabral Mário Luís Casella Gabriel Elias Politi Sandro Nasser Cardoso Luiz Figueiredo Mello Sidney Glina |
| author_sort | Luis Gustavo Morato de Toledo |
| collection | DOAJ |
| description | 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 cmH2O 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. |
| first_indexed | 2024-12-20T13:37:36Z |
| format | Article |
| id | doaj.art-eac51e926e8a493c829b53048b08846b |
| institution | Directory Open Access Journal |
| issn | 1677-5538 1677-6119 |
| language | English |
| last_indexed | 2024-12-20T13:37:36Z |
| publishDate | 2012-10-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-eac51e926e8a493c829b53048b08846b2022-12-21T19:38:54ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-55381677-61192012-10-0138566767310.1590/S1677-55382012000500012Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedureLuis Gustavo Morato de ToledoPedro Henrique Oliveira CabralMário Luís CasellaGabriel Elias PolitiSandro Nasser CardosoLuiz Figueiredo MelloSidney GlinaPURPOSE: 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 cmH2O 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382012000500012Urinary IncontinenceSuburethral SlingsOutcome Assessment (Health Care) |
| spellingShingle | Luis Gustavo Morato de Toledo Pedro Henrique Oliveira Cabral Mário Luís Casella Gabriel Elias Politi Sandro Nasser Cardoso Luiz Figueiredo Mello Sidney Glina Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure International Brazilian Journal of Urology Urinary Incontinence Suburethral Slings Outcome Assessment (Health Care) |
| title | Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure |
| title_full | Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure |
| title_fullStr | Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure |
| title_full_unstemmed | Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure |
| title_short | Prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure |
| title_sort | prognostic value of urethral mobility and valsalva leak point pressure for female transobturator sling procedure |
| topic | Urinary Incontinence Suburethral Slings Outcome Assessment (Health Care) |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382012000500012 |
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