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Predictive Value of Urethral Mobility Before Suburethral Tape Procedure for Urinary Stress Incontinence In Women

2002; Lippincott Williams & Wilkins; Volume: 168; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(05)64171-7

1527-3792

Xavier Fritel, KHALID ZABAK, A Pigné, F. Demaria, Jean‐Louis Bénifla,

Pelvic and Acetabular Injuries

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2002Predictive Value of Urethral Mobility Before Suburethral Tape Procedure for Urinary Stress Incontinence In Women XAVIER FRITEL, KHALID ZABAK, ALAIN PIGNÉ, FABIEN DEMARIA, and JEAN-LOUIS BÉNIFLA XAVIER FRITELXAVIER FRITEL More articles by this author , KHALID ZABAKKHALID ZABAK More articles by this author , ALAIN PIGNÉALAIN PIGNÉ More articles by this author , FABIEN DEMARIAFABIEN DEMARIA More articles by this author , and JEAN-LOUIS BÉNIFLAJEAN-LOUIS BÉNIFLA More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64171-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined whether preoperative urethral mobility predicts the outcome of the suburethral tape procedure outcome in women with urinary stress incontinence. Materials and Methods: This retrospective study included 78 women who underwent preoperative cystourethrography while standing. Proximal urethral support was assessed by lateral cystourethrograms at rest and during straining. The 2 images were anatomically superimposed and the angle formed by the 2 proximal urethra axes determined urethral mobility. Surgical outcome was assessed by stress and pad tests. Results: Median followup was 9 months (range 1 to 37) and the objective success rate was 85% (66 of 78 cases). Median rotation of the proximal urethra was 67 degrees in cases without previous surgery for incontinence, 33 degrees in those with 1 and 28 degrees in those with 2 or more procedures (p <0.0001). The success rate was 97% (29 of 30 cases) when urethral mobility exceeded 60 degrees versus 86% (18 of 21) for mobility between 30 and 60 degrees, and 70% (19 of 27) when it was less than 30 degrees (p = 0.023). The success rate was 96% (26 of 27 cases) without previous surgery for incontinence versus 84% (31 of 37) when 1 unsuccessful procedure had been performed and 64% (9 of 14) with 2 or more surgical failures (p = 0.026). Patient age at surgery, menopausal status, mixed incontinence, body mass index, parity, overactive bladder and low maximal urethral closure pressure had no significant prognostic value. Conclusions: The suburethral sling procedure takes advantage of urethral mobility to avoid leakage. The more the proximal part of the urethra moves while under stress, the better the continence achieved. Risk factors for failure are poor proximal urethral mobility and previous surgery for incontinence. References 1 : An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct1996; 7: 81. 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