Long-term Results of Bladder Neck Suspension: Valsalva Leak Point Pressure as a Predictive Factor of Surgical Outcome in Female Stress Urinary Incontinence

Jeong, Jeong Yoon; Park, Seok San

Abstract

PURPOSE: We retrospectively reviewed the cases of female stress incontinence at our institution to evaluate the value of VLPP(valsalva leak point pressure) in predicting surgical outcome of BNS(bladder neck suspension).
MATERIALS AND METHODS
Ninety-four female patients with stress incontinence who underwent BNS after urodynamic study were investigated retrospectively. Surgical outcomes and patient?s satisfaction were assessed by questionnaires. Surgical outcomes were then analyzed in relation to VLPP and MUCP(maximal urethral closing pressure). Follow-up averaged 27 months.
RESULTS
Mean age was 50 years and mean parity was 2.9. Urinary incontinence completely disappeared in 36 patients(38.2%), significantly improved in 29 patients(30.9%), failed in 29 patients(30.9%). There was a significant relationship between VLPP and failure rate. The failure rate was 44.8%(p=0.015) in patients with low VLPP(< or =60cmH2O) and 36.4%(p=0.67) with low MUCP(< or =20cmH2O).
CONCLUSIONS
We conclude that VLPP is superior to MUCP in predicting surgical outcome after bladder neck suspension for female stress incontinence. This study demonstrates that bladder neck suspension is not a effective procedure for surgical correction of intrinsic sphincter deficiency, therefore another treatment modality should be considered. VLPP is a useful guide in selecting appropriate surgical modality on female stress urinary incontinence.