Predicting the Outcome of Mid-urethral Tape Surgery for Stress Urinary Incontinence Using Preoperative Urodynamics - A Systematic Review
G. Iancu, Gh. PeltecuOriginal article, no. 3, 2014
Urodynamics are currently widely used in most ofurogynecology services, mainly as a diagnostic tool routinelypreoperatively or for complicated cases. The urodynamicparameters, mainly Valsalva leak point pressure (VLPP) andmaximum urethral closure pressure (MUCP), are increasinglyresearched for the promising value in predicting the outcomeof urinary incontinence surgery. Despite the increasingevidence, their predictive role for mid-urethral sling surgeryoutcome is still unclear. We systematically searched theliterature for articles published between January 1990 toJanuary 2014, analysing the value of urodynamic variables inpredicting the outcome of mid-urethral sling surgery. Wecalculated relative risks of failure of surgery for patients withlow MUCP and VLPP compared with those with high values.Low preoperative MUCP was associated with higher risk offailure for both transobturator and retropubic techniques (RR1.83; 95% confidence interval (CI) 1.44-2.33 and RR 1.41;95% CI 1.17-1.69 respectively). Low preoperative VLPP waspredictive as well for higher risk of failure for both transobturatorand retropubic routes (RR 1.76; 95% CI 1.37-2.28 andRR 2.01; 95% CI 1.56-2.60 respectively). Concluding, preoperativeMUCP and VLPP could be used as predictors forpostoperative outcome after mid-urethral sling surgery for SUI.
