Baseline Urodynamic Predictors of Treatment Failure 1 Year After Mid Urethral Sling Surgery

Nager, Charles W.; Sirls, Larry; Litman, Heather J.; Richter, Holly E.; Nygaard, Ingrid; Chai, Toby C.; Kraus, Stephen R.; Zyczynski, Halina M.; Kenton, Kim; Huang, Liyuan; Kusek, John W.; Lemack, Gary E.

doi:10.1016/j.juro.2011.03.105

Cited by 83 publications

(51 citation statements)

References 23 publications

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“…It has been demonstrated that women with MUCP in the lowest quartile are likely to experience failure of mid urethral sling surgery (17) and that MUCP  40 cm H 2 0 is a risk factor affecting cure after transobturator tape procedure (5).…”

Section: Discussionmentioning

confidence: 99%

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

2012

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Introduction: Our purpose was, applying a strictly defi ned protocol for urethral profi lometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests). Materials and Methods:A population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratifi ed in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profi le at rest bladder empty, after bladder fi lling at 250 mL (reference test), stress profi le, fatigability (before (rest) and after 10 successive strong coughs), then in standing position. Results: In all groups, there was no signifi cant difference between the two MUCP values at rest bladder fi lled. In the three incontinent groups, MUCP was higher bladder empty than bladder fi lled (p < 0.05) except in the young sub-group. Stress incontinence led to signifi cant decrease of MUCP during dynamic tests in the young group. MUCP was not modifi ed after fatigability test in women with urge complaint whatever age. Conclusion: When recorded following a strictly defi ned protocol, MUCP at rest bladder fi lled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profi lometry remains discussed in middle-age and old age--groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups. INTRODUCTIONControversies about the role of urethral pressure profi lometry (UPP) in clinical practice (1-3) are mainly based on the reproducibility of the measurements and on the lack of standardization (4).Other main controversies are related to the predictive value of the preoperative maximum urethral closure pressure (MUCP) and the success of the surgery of stress incontinence (5-9) and the postoperative quality of life (10). Conversely, De Lancey (11) found that MUCP was the most characteristic parameter of stress incontinence.In our urodynamic laboratory, we have defi ned a strict protocol for UPP which is routinely applied in order to rule out many causes of variability. It consists of a well-defi ned sequence Vol. 38 (6): 809-817, November -December, 2012 Is a sequence of tests during urethral pressure profi lometry correlated with symptoms assessment in women? ___ _______________________________________________ ____________________________________________

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Section: Discussionmentioning

confidence: 99%

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

2012

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“…In the SISTEr trial, women with USI had better treatment outcomes [11] than women who only demonstrated the sign of SUI but did not have USI. However, in the more relevant trial of midurethral slings (TOMUS), which is the most common surgical treatment offered today, women with USI had worse treatment outcomes than women with the sign of SUI but without USI [12]. Therefore, when stress incontinence is the predominant complaint and it is demonstrable on office evaluation, urodynamic confirmation of this condition adds no apparent benefit to improving outcomes.…”

Section: Confirming the Diagnosis Of Stress Urinary Incontinencementioning

confidence: 99%

“…Markedly different MUCP values are obtained with different measuring technologies [18]. Receiver operator curve outcome data do not suggest there is a biological rationale for cut-off or threshold values for these measures [12]. A recent editorial titled "Intrinsic sphincter deficiency: what is it and does it matter anymore?"…”

Section: Evaluation Of Urethral Functionmentioning

confidence: 99%

Role of Urodynamics in the Evaluation of Urinary Incontinence and Prolapse

Nager

2013

Curr Obstet Gynecol Rep

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Urodynamics are functional tests of the bladder that are commonly requested for the evaluation of urinary incontinence and prolapse. As a diagnostic test that also can provide prognostic information, urodynamics should be requested when there is a specific question that needs to be answered. This chapter will review the literature that pertains to the common reasons for requesting urodynamics before stress urinary incontinence surgery and review recent randomized trials on urodynamic testing before stress incontinence surgery. In addition, the chapter will compare the predictive ability of urodynamic prolapse reduction stress testing with office-based prolapse reduction stress testing for detecting postoperative stress urinary incontinence in women without symptoms of stress urinary incontinence undergoing prolapse surgery.

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“…Investigators have, for example, identified MUCP as a predictor of failure of midurethral slings. 7 Furthermore, understanding the factors affecting urethral closure may lead to novel treatments targeting the urethra. …”

Section: Implications For Treatmentmentioning

confidence: 99%

What causes stress incontinence: Fallacies, fascias and facts

DeLancey

2012

CUAJ

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The traditional view of the pathophysiology of stress urinary incontinence (SUI) was that a loss of urethral support was the primary abnormality present. Recent research has challenged this hypothesis, demonstrating that impaired urethral function plays the key causative role. Improving our understanding of the underlying pathologic mechanisms is important to identifying the cause of treatment failures and for developing novel therapies to treat SUI. O ver the last century, several hypotheses have been proposed to explain the pathophysiology of stress urinary incontinence (SUI). These theories have largely been based on uncontrolled clinical observations or comparing women with stress incontinence to women undergoing urodynamics that did not have stress incontinence (i.e., urge incontinence), focusing on loss of urethral support and an open vesical neck as the primary causative abnormalities. This traditional view of SUI causation has, however, been challenged by recent research investigating the potential role of urethral function in SUI using asymptomatic volunteers for comparison. ROSE studyThe Research On Stress incontinence Etiology (ROSE) study compared measurements of urethral support and function in women with primary SUI to asymptomatic volunteers. 1 This was a casecontrol study involving 103 women with SUI and 108 asymptomatic controls matched for age, race, parity and hysterectomy. The key variables analyzed were maximum urethral closure pressure (MUCP), urethral and pelvic organ support, levator ani muscle function, and intravesical pressure.The study showed that the mean MUCP was 42% lower among women with primary SUI (40.8 cm H 2 O vs. 70.2 cm H 2 O; Fig. 1). MUCP was found to be, by far, the strongest predictor of SUI; the effect size (1.47) was substantially higher than that of any other single predictor. In fact, after adjusting for body mass index (BMI), MUCP alone correctly classified 50% of cases. No measure of urethral support had an effect size greater than 0.6. Ultrasound investigationThe investigators of the ROSE study were surprised by their findings that MUCP was the most powerful predictor, with an effect size so much greater than any of the urethral mobility variables assessed in the study. To alleviate concerns that they had not included the correct urethral mobility parameter in their assessments, they subsequently performed a secondary analysis of ultrasound videos of the ROSE subjects' urethral mobility during coughing. 2 This was carried out by a panel of international experts who were asked to identify which patterns they felt were most likely to be associated with stress incontinence.The investigators were surprised to discover that none of the experts were able to consistently discern which women were stress incontinent and which were continent based on review of the ultrasounds alone. Indeed, the mean accuracy of these evaluators was 57.4% (i.e., only 7% better than the success rate one would expect by random chance). This finding further supports the concept that ure...

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Baseline Urodynamic Predictors of Treatment Failure 1 Year After Mid Urethral Sling Surgery

Cited by 83 publications

References 23 publications

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

Role of Urodynamics in the Evaluation of Urinary Incontinence and Prolapse

What causes stress incontinence: Fallacies, fascias and facts

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