Changes in urodynamic measures two years after Burch colposuspension or autologous sling surgery
Stephen R Kraus, Gary E Lemack, Holly E Richter, Linda Brubaker, Toby C Chai, Michael E Albo, Larry T Sirls, Wendy W Leng, John W Kusek, Peggy Norton, Heather J Litman, Urinary Incontinence Treatment Network, Elizabeth A Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Thomas Rozanski, Peggy Norton, Ingrid Nygaard, Sharon Tennstedt, Anne Stoddard, Debuene Chang, Marva Moxey-Mims, Rebekah Rasooly, Amy Arisco, Jan Baker, Diane Borello-France, Kathryn L Burgio, Ananias Diokno, Melissa Fischer, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Margie Kahn, Jerry Lowder, Karl Luber, Emily Luckacz, Alayne Markland, Shawn Menefee, Pamela Moalli, Elizabeth Mueller, Pradeep Nagaraju, Kenneth Peters, Elizabeth Sagan, Joseph Schaffer, Amanda Simsiman, Robert Starr, Gary Sutkin, R Edward Varner, Laura Burr, JoAnn Columbo, Tamara Dickinson, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, D Lynn Kalinoski, Barbara Leemon, Kristen Mangus, Karen Mislanovich, Elva Kelly Moore, Caren Prather, Sylvia Sluder, Mary Tulke, Robin Willingham, Kimberly Woodson, Gisselle Zazueta-Damian, Kimberly J Dandreo, Liyuan Huang, Rose Kowalski, Heather Litman, Marina Mihova, Anne Stoddard, Kerry Tanwar, Sharon Tennstedt, Yan Xu, J Quentin Clemens, Paul Abrams, Diedre Bland, Timothy B Boone, John Connett, Dee Fenner, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters, Stephen R Kraus, Gary E Lemack, Holly E Richter, Linda Brubaker, Toby C Chai, Michael E Albo, Larry T Sirls, Wendy W Leng, John W Kusek, Peggy Norton, Heather J Litman, Urinary Incontinence Treatment Network, Elizabeth A Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Thomas Rozanski, Peggy Norton, Ingrid Nygaard, Sharon Tennstedt, Anne Stoddard, Debuene Chang, Marva Moxey-Mims, Rebekah Rasooly, Amy Arisco, Jan Baker, Diane Borello-France, Kathryn L Burgio, Ananias Diokno, Melissa Fischer, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Margie Kahn, Jerry Lowder, Karl Luber, Emily Luckacz, Alayne Markland, Shawn Menefee, Pamela Moalli, Elizabeth Mueller, Pradeep Nagaraju, Kenneth Peters, Elizabeth Sagan, Joseph Schaffer, Amanda Simsiman, Robert Starr, Gary Sutkin, R Edward Varner, Laura Burr, JoAnn Columbo, Tamara Dickinson, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, D Lynn Kalinoski, Barbara Leemon, Kristen Mangus, Karen Mislanovich, Elva Kelly Moore, Caren Prather, Sylvia Sluder, Mary Tulke, Robin Willingham, Kimberly Woodson, Gisselle Zazueta-Damian, Kimberly J Dandreo, Liyuan Huang, Rose Kowalski, Heather Litman, Marina Mihova, Anne Stoddard, Kerry Tanwar, Sharon Tennstedt, Yan Xu, J Quentin Clemens, Paul Abrams, Diedre Bland, Timothy B Boone, John Connett, Dee Fenner, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters
Abstract
Objective: To characterize the urodynamic (UDS) changes in subjects 24 months after Burch urethropexy and autologous fascial sling surgery for stress urinary incontinence.
Methods: In the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr), 655 women underwent standardized UDSs before and 2 years after Burch or sling surgery. Paired t tests were used to compare the pre- and postoperative UDS measures by treatment group. Analysis of variance models were fit predicting the change in UDS measures, controlling for the treatment group.
Results: The noninstrumented maximal flow rate decreased 3.6 mL/s in the Burch group and 4.7 mL/s in the sling group (P = .42). The average flow rates also decreased (2.4 mL/s in the Burch group and 3.8 mL/s in the sling group, P = .039). No difference was found in the increases in first sensation between the Burch and sling groups (23.3 and 29.3 mL, respectively, P = .61). Also, no differences were found in the reduction in the pressure flow study maximal flow rates (2.3 mL/s in the Burch group and 4.4 mL/s in the sling group, P = .11). An increased detrusor pressure at maximal flow rate (11.4 cm H(2)O, P < .001) was seen only after the sling procedure. Increases in the bladder outlet obstruction index occurred after both procedures, with greater increases seen after sling surgery (change, Burch +6.27 vs sling +20.12, P = .001).
Conclusion: The Burch colposuspension and autologous fascial sling procedures were associated with similar decreases in noninstrumented flow rates, and the sling was associated with greater increases in the detrusor pressure at maximal flow rate and bladder outlet obstruction index. These changes suggest that both procedures are effective, in part, because of increased outlet resistance. However, the sling procedure might be more obstructive.
Copyright © 2011 Elsevier Inc. All rights reserved.
Source: PubMed