Is transobturator tape as effective as tension-free vaginal tape in patients with borderline maximum urethral closure pressure?

Jay James R. Miller, Sylvia M. Botros, Mohamed N. Akl, Sarit O. Aschkenazi, Jennifer L. Beaumont, Roger P. Goldberg, Peter K. Sand

Research output: Contribution to journalArticlepeer-review

93 Scopus citations

Abstract

Introduction: The purpose of this study was to compare transobturator tape (MONARC) with tension-free vaginal tape in patients with borderline low maximum urethral closure pressure. Study design: Historical cohort analysis of 3-month outcomes in 145 subjects (MONARC = 85; tension-free vaginal tape = 60). A cut-off point of 42 cm H2O for preoperative maximum urethral closure pressure was identified as predictor of success in the entire cohort. The cohort was stratified by sling type and analyzed. Outcome variables included urodynamic stress incontinence, urethral pressure profiles, subjective stress incontinence symptoms, and complications. Results: The relative risk of postoperative urodynamic stress incontinence 3 months after surgery in patients with a preoperative maximum urethral closure pressure of 42 cm or less H2O was 5.89 (1.02 to 33.90, 95% confidence interval) when we compared MONARC with tension-free vaginal tape. Subjects in the MONARC and tension-free vaginal tape groups did not differ significantly in baseline characteristics. We defined subjects as failures if they demonstrated postoperative objective stress incontinence on multichannel urodynamic testing. Conclusion: In subjects with maximum urethral closure pressure of 42 cm or less H2O, the MONARC was nearly 6 times more likely to fail than tension-free vaginal tape at 3 months after surgery. Long-term follow-up and randomized controlled trials are needed.

Original languageEnglish (US)
Pages (from-to)1799-1804
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume195
Issue number6
DOIs
StatePublished - Dec 1 2006
Externally publishedYes

Keywords

  • Incontinence surgery
  • Maximum urethral closure pressure
  • Stress urinary incontinence
  • Tension-free vaginal tape
  • Transobturator tape

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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