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abstract

400 - OFFICE CYSTOMETRY TO PREDICT SURGICAL OUTCOME IN STRESS URINARY INCONTINENCE PATIENTS

400

OFFICE CYSTOMETRY TO PREDICTSURGICAL OUTCOME IN STRESS URINARY INCONTINENCE PATIENTS

T. RABY1, B. BLUMEL2, S. POLHAMMER 1, M. ARELLANO 2, R.H. CUEVAS 3, A. PATTILLO 4, S. VIGUERA 5,J. PIZARRO-BERDICHEVSKY 1;
1UrogynecologyUnit; División Obstetricia y Ginecología, Dr. Sótero del RioHosp.-Pontificia Univ. Católica de Chile, Santiago, Chile,2Urogynecology Unit, Dr. Sótero del Rio Hosp.-ClínicaSanta María, santiago, Chile, 3Urogynecology Unit;División Obstetricia y Ginecología, Dr. Sótero del RioHosp.-Pontificia Univ. Católica de Chile, santiago, Chile,4Urogynecology Unit, Dr. Sótero del Rio Hosp.-ClínicaAlemana Puerto varas, Puerto Varas, Chile, 5PONTIFICALCATHOLIC Univ. OF CHILE, SANTIAGO, Chile.

Introduction: Stress urinaryincontinence (SUI) is a condition frequently seen in women.Midurethral slings (MUS) are the current standard surgical technique,and have been proven to be safe and effective. Some urodynamic study(UDS) parameters have been proposed to predict MUS surgeries success.The most common are: Valsalva Leak Point Pressure (VLPP) and MildUrethral Closure Pressure (MUCP). However UDS are expensive, andtherefore with limited availability. Recent studies have not provenits superiority over stress test for evaluating SUI. Among othersthis could be a reason to explore other preoperative evaluationoptions. Our public hospital cannot provide multichannel UDS to allour patients. For that reason, our section established in 2011 astandardized office base evaluation for all SUI patients, includingan office cystometry (OC) where different parameters areinvestigated.
Objective: The aim of our study is to reportthe results of MUS surgery with preoperatory OC and to identifypotential OC predictors factors of SUI recurrence using a compositeoutcome (reoperation for SUI or SUI during physical exam or SUIsymptoms) We hypothesized that leakage with an empty bladder and/orvalsalva SUI with 100cc during OC may predict recurrence.
Methods:We performed a retrospective analysis from our prospective collecteddatabase. Inclusion criteria: MUS surgery performed after 2011, OCperformed, available follow up. Exclusion criteria: Incompleteinformation in the database, non-polypropylene slings. Briefly, theOC evaluates the occurrence of empty bladder leakage (defined asleakage with PVR < 50 ml), PVR evaluation, a filling phase aimingto interrogate detrusor overactivity (DO) and Valsalva SUI evaluationwith 100, 200 and 300cc. All parameters are registered instandardized report. After extracting the data from the database, weanalyzed descriptive demographic data, surgery details and follow up.Results are shown as mean ± standard deviation, median(interquartile range) or number (percentage) as appropriate. T-Test,Mann Whitney U, Chi square or Fisher exact test was used asappropriate. Multivariable analysis was performed using CoxProportional hazards model.
Results: 604 patients wereincluded. Demographics and clinical characteristics: Age 56±10.3years, BMI 30.5±4,5 kg/cm2, parity 3±1.6 children, stageIII/IV POP 167 (41.1%), previous hysterectomy 77 (12.7%), previousprolapse surgery 13 (2.2%). 514 (85.1%) had current SUI and 90(14.9%) had occult SUI. The OC showed SUI in 584 (98.3%) patients, DOin 134 (22.2%) patients and sensitive urgency in 188 (31.1%). In 257(42.6%) patients had urinary leakage with empty bladder and 209(34.6%) had leakage with 100 cc in OC. In 439 (72.7%) patients a TVTwas implanted and 165 (27.3%) had a TOT. Concomitant surgery forapical defects was done in 178 (29.4%) and in 163 (27%) an anteriorcolporrhaphy was made. Median follow-up, to primary outcome or lastfollow-up visit if outcome was not meet, was 7.5 months (1.8-19.7).Composite surgical outcome was reported in 42 (7%) patients. TOT andTVT failure was 5.5% and 7.5%, respectively. There was no differencein failure rate in relation to the type of sling used (p = 0.243).Patients with mixed SUI had a 15.3% failure rate, while pure SUI andoccult SUI, had a 4.8% y 4.2% failure rate, respectively (p <0.001). Failure rate in patients with urinary empty bladder leakagewas 8.6% in comparison with a 5.8% of the patients without emptybladder leakage (p=0.185). In patients with 100cc bladder leakage,the failure rate was 8.6%. After a Cox Proportional hazard analysis,the only parameter of OC that showed differences in Surgicalcomposite outcome, was intense urinary leakage with 100cc. When thiscondition is present, the failure risk 9.8% vs. 6.2% (OR 2.86, CI 95%1.04-7.8).
Conclusions: In our cohort, intense urinaryleakage with 100cc, in OC, was the only predictor factor for SUIrecurrence. Interestingly, Mixed SUI patients had greater risk ofrecurrence than those with pure SUI or occult SUI.
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