Mid-Urethral Sling for Stress Incontinence: Does Urodynamic Pressure Reading Affect Post-Operative Outcome?

The aim of our study was to determine the effect of preoperative urodynamic reading of valsalva leak point pressure on the result of mid-urethral sling surgery. From January 2010 to December 2014, a total of 207 patients underwent mid-urethral sling surgery at the Toronto Western Hospital. An incontinence questionnaire was sent to 94 patients who accepted to be involved in the study to examine satisfaction post-surgery. Forty-five patients replied and were included in the analysis. The patients were divided into three groups according to valsalva leak point pressure (< 60, 60-80 and > 80 cm H2O) determined on urodynamic testing. Of the forty-five patients who responded to the questionnaire, seven were excluded for only having had stress testing done and two were excluded due to intermittent catheterization. Thirteen patients had evidence of detrusor overactivity on urodynamic testing. Simple linear regression analysis was done for the three groups of the valsalva leak point pressure values and correlation to satisfaction was found -0.263, -0.236, and -0.148, respectively. In this current study, we could not find a relation between valsalva leak point pressure values and the self-reported satisfaction post-surgical correction.

Leak point pressure at different bladder volumes in stress urinary incontinence in women: Comparison between Valsalva and coughinduced leak point pressure

Introduction: We compared Valsalva leak point pressure (VLPP) in urodynamically proven stress urinary incontinence (SUI) in women at different bladder volumes; examined the relationship between VLPP and cough-induced leak point pressure (CLPP) compared by incontinence severity; and evaluated the influence of bladder volume on each leak point pressure (LPP).Methods: Women with urodynamically proven SUI who underwent serial VLPP and CLPP measurement at bladder volumes of 150, 200, 250, and 300 mL were included in this study (n=228). LPP determination was repeated two times in each subject after finishing one series of LPP measurement. LPP at different bladder volumes was compared by subjective symptom severity of Stamey grade.Results: Patients mean age was 51.3±7.6 years (range: 40‒65 years). Stamey grade I, II, and III was assigned to 68 (29.8%), 102 (44.7%), and 58 (25.4%) patients, respectively. Mean CLPP was higher than VLPP (p=0.002) at every bladder volume. VLPP and CLPP were significantly decreased by the increase of bladder volume (p=0.001). The mean first positive LPPs were significantly lower at higher Stamey grade (p=0.004).Conclusions: LPP is more frequently induced by cough than by the Valsalva maneuver. VLPP and CLPP decreased significantly with bladder filling and those with severe symptoms of SUI are more likely to have low LPP.