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Z. NG, H. HAN;
Department ofUrogynaecology, KK Women's and Children's Hosp., Singapore,Singapore.

Introduction: Various factorshave been investigated for their association with the outcome ofmid-urethral sling (MUS) surgery.
Objective: Ourinstitution routinely performs pre-operative and 6 monthpost-operative urodynamic evaluation for patients. We aimed to assessthe predictive value of demographic and urodynamic parameters inpredicting postoperative outcomes.
Methods: A total of 606cases of pure MUS were conducted between 1999 and 2015. Data for 500cases were available, and the remaining cases were lost to follow-upor had missing data. The retropubic approach (TVT or TVT-Exact) wasselected for patients with low preoperative maximum urethral closurepressure (MUCP) and the transobturator route (TVT-Obturator orTVT-Abbrevo) was used in patients with normal MUCP, although this wasultimately dependent on the surgeon’s discretion and patient'spreference. Treatment failure was defined by subjective complaint ofstress urinary incontinence (SUI) and/or demonstrable SUI onexamination at 1 year follow-up. Patients were separately analysedbased on whether they underwent trans-obturator or retropubicMUS.
Results: In both groups, a higher pre-operative MUCPwas not significantly associated with treatment success. In theretropubic MUS group, there was a significant increase inpost-operative MUCP in the treatment success group (mean +6.2cmH2O,p=0.02), with no significant change in the failure group. There wasno significant association between the pre-operative urethralfunctional length and volume of leak on treatment outcome. A higherBMI, particularly above 30, was significantly associated with failurein the trans-obturator surgery group. More vaginal births, previoussurgery for SUI and co-existent urgency or urge urinary incontinencewere also significantly associated with treatment failure in thetrans-obturator group. However, these factors did not reachsignificance in the retropubic MUS group.

Conclusions: There areconflicting data on factors that predict the outcome of MUS surgery.Some studies have demonstrated an association between pre-operativeurodynamic parameters, such as MUCP, on postoperative outcomes. Ourfindings, however, did not support this. Our data suggested thatpost-operative urodynamic evaluation may add valuable informationabout treatment outcome, with an increase in MUCP correlating withtreatment success. We also found a significant association betweengreater number of vaginal births, higher BMI, a post-menopausalstatus, recurrent instead of primary surgery, and the presence ofconcomitant urgency with a higher chance of failure in thetrans-obturator group. Further research is still necessary to bettercharacterise the factors that accurately predict failure. Thoroughpre-operative counselling is crucial to manage the outcomeexpectations of MUS surgery.

Int Urogynecol J(2012) Jul;23(7):813-22.

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