Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings. Analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

Elisabetta Costantini, Massimo Lazzeri, Antonella Giannantoni, Vittorio Bini, Alberto Vianello, Ervin Kocjancic, Massimo Porena

Research output: Contribution to journalArticle

Abstract

Objective: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). Materials and Methods: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Results: Mean follow-ups were 32 ± 12 months (range 12-55) for TVT and 31 ± 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP≤60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP≤60 cm H2O (p <0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82 % vs. 68.9% p <0.172); VLPP≤60 cm H2O (68% vs. 76% p <0.528). Conclusions: When patients were stratified for preoperative VLPP(≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.

Original languageEnglish
Pages (from-to)73-83
Number of pages11
JournalInternational Braz J Urol
Volume34
Issue number1
Publication statusPublished - Jan 2008

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Suburethral Slings
Randomized Controlled Trials
Pressure
Stress Urinary Incontinence
Urethra
Visual Analog Scale
Patient Satisfaction
Quality of Life
Equipment and Supplies

Keywords

  • Tension free vaginal tape
  • Transobturator tape
  • Urinary incontinence
  • Valsalva leak point pressure

ASJC Scopus subject areas

  • Nephrology
  • Urology

Cite this

Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings. Analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings. / Costantini, Elisabetta; Lazzeri, Massimo; Giannantoni, Antonella; Bini, Vittorio; Vianello, Alberto; Kocjancic, Ervin; Porena, Massimo.

In: International Braz J Urol, Vol. 34, No. 1, 01.2008, p. 73-83.

Research output: Contribution to journalArticle

Costantini, Elisabetta ; Lazzeri, Massimo ; Giannantoni, Antonella ; Bini, Vittorio ; Vianello, Alberto ; Kocjancic, Ervin ; Porena, Massimo. / Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings. Analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings. In: International Braz J Urol. 2008 ; Vol. 34, No. 1. pp. 73-83.
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abstract = "Objective: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). Materials and Methods: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Results: Mean follow-ups were 32 ± 12 months (range 12-55) for TVT and 31 ± 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5{\%}) patients showed a VLPP > 60 cm H2O and 50 (34.5{\%}) patients had a VLPP≤60 cm H2O. The overall objective cure rates were 75.8{\%} for patients with VLPP > 60 cm H2O and 72{\%} for those with VLPP≤60 cm H2O (p <0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82 {\%} vs. 68.9{\%} p <0.172); VLPP≤60 cm H2O (68{\%} vs. 76{\%} p <0.528). Conclusions: When patients were stratified for preoperative VLPP(≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.",
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T1 - Preoperative Valsava leak point pressure may not predict outcome of mid-urethral slings. Analysis from a randomized controlled trial of retropubic versus transobturator mid-urethral slings

AU - Costantini, Elisabetta

AU - Lazzeri, Massimo

AU - Giannantoni, Antonella

AU - Bini, Vittorio

AU - Vianello, Alberto

AU - Kocjancic, Ervin

AU - Porena, Massimo

PY - 2008/1

Y1 - 2008/1

N2 - Objective: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). Materials and Methods: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Results: Mean follow-ups were 32 ± 12 months (range 12-55) for TVT and 31 ± 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP≤60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP≤60 cm H2O (p <0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82 % vs. 68.9% p <0.172); VLPP≤60 cm H2O (68% vs. 76% p <0.528). Conclusions: When patients were stratified for preoperative VLPP(≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.

AB - Objective: To test the hypothesis that preoperative Valsalva leak point pressure (VLPP) predicts long-term outcome of mid-urethra slings for female stress urinary incontinence (SUI). Materials and Methods: One hundred and forty-five patients with SUI were prospectively randomized to two mid-urethra sling treatments: Tension free vaginal tape (TVT) or transobturator tape (TOT). They were followed-up at 3, 6, 12 months post-operatively and then annually for the primary outcome variable, i.e. dry or wet and secondary outcome variables such as scores on the urogenital distress inventory (UDI-6) and the impact of incontinence on quality of life (IIQ-7) questionnaire as well as patient satisfaction as scored on a visual analogue scale (VAS). Preoperative VLPP was correlated with primary and secondary outcome variables. Results: Mean follow-ups were 32 ± 12 months (range 12-55) for TVT and 31 ± 15 months (range 12-61) for TOT. When patients were analyzed according to VLPP stratification, 95 (65.5%) patients showed a VLPP > 60 cm H2O and 50 (34.5%) patients had a VLPP≤60 cm H2O. The overall objective cure rates were 75.8% for patients with VLPP > 60 cm H2O and 72% for those with VLPP≤60 cm H2O (p <0.619). No significant differences in objective cure rates emerged when patients were stratified for pre-operative VLPP and matched for TOT or TVT procedures: VLPP > 60 cm H2O (82 % vs. 68.9% p <0.172); VLPP≤60 cm H2O (68% vs. 76% p <0.528). Conclusions: When patients were stratified for preoperative VLPP(≤ or > of 60 cm H2O), preoperative VLPP was not linked to outcome after TVT or TOT procedures.

KW - Tension free vaginal tape

KW - Transobturator tape

KW - Urinary incontinence

KW - Valsalva leak point pressure

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