Correlation Of Pre-Operative Abdominal Leak Point Pressure With Post-Operative Stress Urinary Incontinence

CORRELATION OF PRE-OPERATIVE ABDOMINAL LEAK POINT PRESSURE WITH POST-OPERATIVE STRESS URINARY INCONTINENCE AFTER CYSTOCELE REPAIR AND SLING

*Sam J. Kuykendall, M.D., Maggie D. Vuturo, M.D., Gary E. Leach, M.D.
Los Angeles, CA

INTRODUCTION AND OBJECTIVE:

It is unknown if the severity of stress urinary incontinence (SUI) on pre-operative urodynamic studies correlates with a patient’s likelihood of persistent SUI after cystocele repair with sling. No previous studies have evaluated the correlation of pre-operative abdominal leak point pressures (ALPP) with incidence and severity of SUI after cystocele repair with sling placement.

METHODS:

A retrospective review was performed examining 420 patients who underwent cystocele repair with simultaneous suburethral sling. All patients had both pre-operative urodynamic studies (UDS) and follow-up with a validated incontinence questionnaire. UDS were performed in all patients with and without reduction of the cystocele. All patients underwent sling placement regardless of pre-operative UDS findings. Sling types included transobturator sling, single incision sling and cadaveric fascial sling. Presence and severity of patient SUI was self-reported in a validated questionnaire post-operatively.

RESULTS:

Of 424 patients analyzed who underwent cystocele repair and sling, 185 demonstrated SUI on pre-operative urodynamic studies. The remaining 239 patients did not show SUI during pre-operative UDS.

There was no detectable difference in the proportion of patients with or without post-operative SUI in any of the three groups with pre-op SUI based on pre-operative ALPP (p=0.67 for LO v MID or HI v MID; p=1.0 for LO v HI). We estimated the 95% confidence interval for the difference to be ± 18% (LO v MID or HI v MID) and + 22% (LO v HI). There was no statistically significant difference between the three groups when compared to the 239 patients who were dry pre-operatively as well. Additionally, ALPP did not correlate with post-operative SUI based on sling type.

CONCLUSIONS:

Despite suburethral sling placement at the time of cystocele repair, some patients experience post-operative SUI which is usually reported as mild. There is no evidence for a direct correlation between ALPP on pre-operative urodynamics and the likelihood of continued SUI after cystocele repair with sling placement.