SUFU 2020: Preoperative Urodynamic Findings Among Men Undergoing Transobturator Male Sling

Scottsdale, Arizona (UroToday.com) The authors aimed in this retrospective chart review to evaluate pre-operative urodynamic findings in patients undergoing transobturator male sling (TMS). All TMS performed from 8/2006-6/2012 by a single surgeon were identified. Patients without urodynamics were excluded (n=31). The primary variables of interest were pre-operative urodynamic parameters and the success of the surgery. Success was defined as zero pads or >50% improvement and satisfaction without further intervention. Multiple logistic regression was used to evaluate the impact of urodynamics findings on overall success.

There were 184 patients identified for inclusion in the study. The mean (SD) age was 67.9 (8.1) years and mean (SD) BMI was 28.4 (3.7). Thirty-nine (21.2%) patients had a history of radiation. 90.8% had a prior prostatectomy. 54 (29.4%) patients had mild SUI (≤2PPD),74 (40.2%) had moderate SUI (3-4ppd), and 56 (30.4%) had severe SUI (≥5ppd).

On urodynamics,62 (33.7%) patients demonstrated detrusor overactivity (DO). The mean (SD) Valsalva leak point pressure was 56.2 (31.7). Mean (SD) maximum detrusor pressure was 25.2 (18.4). Mean (SD) max flow 16.2 (11.5). 176 (95.7%) had normal compliance. Mean (SD) post void residual (PVR) was <100mL in 172 (93.5%). Following TMS,134 (73.2%) patients reported improvement and were classified as a success.

On multiple logistic regression adjusting for age, a prior procedure for vesicourethral anastomosis stenosis, the severity of SUI, presence of DO, max detrusor pressure, normal compliance, and elevated pre-operative PVR. DO was associated with significantly decreased odds of success (OR 0.32,95% CI 0.15-0.71, p=0.005). Severe SUI was associated with a non-statistically significant decreased odds of success (OR 0.41,95% CI 0.15-1.10, p=0.077). The remaining variables were not predictive of success or failure.

The authors concluded at the end that men undergoing TMS have variable findings on pre-operative urodynamics. The presence of DO is associated with the failure of the TMS. Identifying men with DO through the use of urodynamics and treating these patients prior to surgery may improve outcomes and better identify which patients are at higher risk of failure. Urodynamics should be strongly considered in any patient with a component of urgency during an evaluation

Presented by: Maria Francesca Monn, MD, MPH,Department of Urology,Eastern Virginia Medical School.

Co-Authors: Michael E Chua,¹ Jack M Zuckerman,¹ Jessica M DeLong,¹ Ramon Virasoro,¹ Kurt McCammon¹

Eastern Virginia Medical School

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona

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