Is Pressure Transmission Ratio in Genuine Stress Urinary Incontinence a Good Parameter of Success after Operation?

Kim, Young Cheoi; Lee, You Sik; Seo, Ju Tae

Abstract

Pressure transmission ratio (PTR; A urethral pressure/A bladder pressure x 100) is obtained during cough profile and has been extensively used in pre and postoperative evaluation of patients with genuine stress urinary incontinence. The purpose of this study is to evaluate which urodynamic parameters are most effective for the decision of success after Burch operation in patients with genuine stress urinary incontinence. Twenty-one women with genuine stress urinary incontinence were evaluated urodynamically both before and after Burch operations. The patients` age was 49.5+/-7.51 and parity, 3.1+/-1.5. Mean follow up period was 8.7 months after operations (range 3-36 months). Dynamic and static urethral pressure profilometry were measured with microtip transducer catheter pre and postoperatively. The preoperative and postoperative functional urethral length (2.76+/-0.48 vs 2.75+/-0.47cm, p>0.05) and maximal urethral closure pressure (71.9+/-15.7 vs 72.8+/-15.2cmH20, p>0.05) showed no significant changes after eighteen successful Burch procedures. The PTR at the points of MUCP (maximal urethral closure pressure) was significantly improved after eighteen successful surgeries (85.9+/- 10.9 vs 113.4+/-13.5%, p<0.001). Three women who remained incontinent, showed no improvement in PTR (76.3+/-4.16 vs 86.7+/-8.5%, p>0.05). The reasons for successful surgical treatment of stress urinary incontinence are not related to any changes in functional urethral length or maximal urethral closure pressure. However, the comparison of preoperative and postoperative PTR is helpful and objective in determining the adequacy of surgical correction of anatomical defect associated with genuine stress urinary incontinence.