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Transobturator slings for stress incontinence: using urodynamic parameters to predict outcomes
N L Guerette1, J F Bena, G W Davila
1Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
Summary
Preoperative urodynamic parameters like Valsalva leak point pressure at cystometric capacity and maximum urethral closure pressure can predict transobturator sling success for stress incontinence. Impaired urethral function may require cautious use of transobturator slings.
Area of Science:
- Urology
- Female Pelvic Medicine
- Urodynamics
Background:
- Stress urinary incontinence (SUI) with urethral hypermobility affects many women.
- Transobturator slings (TOS) are a common surgical treatment for SUI.
- Predicting surgical success remains a clinical challenge.
Purpose of the Study:
- To evaluate preoperative urodynamic urethral function parameters for predicting TOS success.
- To identify specific urodynamic markers associated with continence outcomes after TOS.
Main Methods:
- Seventy women with SUI and urethral hypermobility underwent Monarc TOS.
- Postoperative continence was correlated with preoperative urodynamic parameters.
- Mathematical modeling assessed predictive capabilities of parameters like Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP).
Main Results:
- 80% of patients achieved continence at 8.1-month follow-up.
- Median VLPP at cystometric capacity (VLPPcap) and MUCP were significantly higher in continent patients (p < 0.001).
- Cutoff values of VLPPcap > 60 cmH2O and MUCP > 40 cmH2O predicted success with 83% sensitivity and 79% specificity.
Conclusions:
- A combination of preoperative urodynamic parameters can predict continence rates after TOS.
- Transobturator slings should be used cautiously in women with impaired urethral function.
