Comparison of preoperative and postoperative pressure transmission ratio and urethral pressure profilometry in patients with successful outcome following the vaginal wall patch sling technique

Abstract

Aims: We studied preoperative and postoperative pressure transmission ratio (PTR) and urethral pressure profilometry in patients undergoing the vaginal wall patch sling technique as a first surgical approach for genuine stress incontinence (GSI) with urethral hypermobility. The specific aims were to determine the exact urodynamic parameters, if any, that may be improved postoperatively and to report the urodynamic outcome of the vaginal wall patch sling technique in successful cases.

Methods: Preoperatively, all patients had a positive standing stress test, urethral hypermobility on Q-tip testing, and normal postvoid residual volume. On urodynamics, all patients had equalization of maximum urethral closure pressure (MUCP) on cough profilometry, and absence of detrusor contractions on subtracted cystometry. The PTR for each cough was calculated. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length (FUL). Urethral pressure profilometry was performed at bladder capacity in the sitting position. All urodynamic tests were repeated 3-6 months postoperatively. A two-tailed t-test was used for statistical analysis.

Results: Forty-eight patients demonstrated successful outcome at initial follow up and constituted the study population. There was a statistically significant increase in MUCP at stress as well as a statistical increase in PTR in the first, second, and third quartiles of the FUL postoperatively.

Conclusions: The vaginal patch sling technique appears to restore continence both by buttressing the urethra at times of stress as well as repositioning the proximal urethra into the intra-abdominal pressure zone, thus, enhancing pressure transmission to the proximal urethra.