FEMALE UROLOGY

Does Valsalva leak point pressure predict outcome after the distal urethral polypropylene sling? Role of urodynamics in the sling era
Rodriguez LV, de Almeida F, Dorey F, Raz S
Departments of Urology, The Geffen School of Medicine at the University of California Los Angeles,
Los Angeles, California, USA
J Urol. 2004; 172: 210-4

• Purpose: Recently sling procedures have been shown to be effective in the treatment of all types of incontinence. In this study we evaluated the role of preoperative Valsalva leak point pressure (VLPP) in predicting the outcome of sling surgery.
• Materials and Methods: We prospectively evaluated 174 consecutive patients who underwent a distal polypropylene sling procedure for the treatment of stress urinary incontinence (SUI). Using SEAPI scores patients were divided by VLPP into group 1-60 patients who did not leak on urodynamics, group 2-27 patients with VLPP greater than 80 cm H2O, group 3-71 patients with VLPP 30 to 80 cm H2O and group 4-16 patients with VLPP less than 30 cm H2O. Surgical outcomes were determined by symptom, bother and quality of life questionnaires filled out by patients. The physicians were blinded to patient response.
• Results: Mean followup was 14.7 months (range 12 to 30) and mean patient age was 62 years (range 32 to 88). The groups were well matched before surgery with respect to age, number of previous surgeries, and severity of SUI symptoms and urge incontinence. The percentage of patients who were cured or improved was similar among groups. After surgery there was no statistical difference among patient mean self-reported symptoms of or bother from SUI or urge incontinence.
• Conclusions: The distal urethral polypropylene sling provides similar symptom improvement in all patients regardless of preoperative VLPP. VLPP is helpful in the diagnosis of SUI but appears to be of minimal benefit in predicting the outcome of the distal urethral polypropylene sling procedure.
  
  
• Editorial Comment
  The authors review the Valsalva leak point pressures obtained preoperatively before the placement of a distal urethral polypropylene sling and then correlate those values with the outcome of sling surgery. This paper is well written and is of great value. It was noted that the valsalva leak point pressure was helpful in evaluating stress urinary incontinence but could not accurately predict which patients would be a surgical success or not. This further highlights the utility of the minimally invasive sling procedure as a therapeutic option for all degrees of stress urinary incontinence. The authors found that patients with lower valsalva leak point pressures were likely to have significantly more severe stress urinary incontinence symptoms. This finding has been noted before (1). The value and role of urodynamic testing in stress urinary incontinence has been a long time subject of discussion in the field of urology (2). This academic contribution continues that intellectual discourse.

REFERENCES
1. Nitti VW, Combs AJ: The correlation of valsalva leak point pressure with subjective degree of stress urinary incontinence in women. J Urol. 1996; 155: 2815.
2. McGuire EJ, Lytton B, Kohorn EI, Pepe V: The value of urodynamic testing in stress urinary incontinence. J Urol. 1980; 124: 256-8.

Dr. Steven P. Petrou
Associate Professor of Urology
Mayo Clinic College of Medicine
Jacksonville, Florida, USA