Outcome of TVT operations in women with low maximum urethral closure pressure

(i) To establish whether low maximal urethral closure pressure (MUCP) is associated with a poorer prognosis after TVT-surgery, and if so to establish an MUCP cut-off value for poor outcome. (ii) To characterize the population with a low MUCP.

Retrospective analysis of data from 6,646 women with stress/mixed urinary incontinence included in the Norwegian Female Incontinence Registry. Postoperative subjective (degree of satisfaction), objective (leakage on stress test) and composite cure according to preoperative MUCP were analyzed in unadjusted and adjusted analysis. Preoperative variables were compared between women having a low or normal MUCP. Non-parametric tests were used on continuous variables and χ² tests on categorical variables. Logistic regression was used for the adjusted analysis. Level of significance: P < 0.05.

An analysis of centiles of preoperative MUCP showed that a cut-off at 20 cm H₂ O did best identify women at risk of not being cured. In unadjusted analysis MUCP ≤20 cm H₂ O (n = 422) was associated with objective (OR: 2.48), subjective (OR: 1.60), and composite failure (OR: 1.95) compared to MUCP >20 cm H₂ O. In adjusted analysis MUCP ≤20 cm H₂ O was associated with neither objective, subjective, nor composite failure. Women with MUCP <20 cm H₂ O were preoperatively significantly older, had larger leakage on stress and 24 h pad test, lower mean voided volume and maximum flow rate and higher stress and urge indices.

Women with MUCP ≤20 cm H₂ O have similar objective, subjective, and composite outcomes after TVT-surgery compared to women with MUCP >20 cm H₂ O after adjusting for preoperative variables. Neurourol. Urodynam. 36:1320-1324, 2017. © 2016 Wiley Periodicals, Inc.