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Valsalva leak point pressure (VLPP) greater than 70 cm H2O is an indicator for sling success: a success prediction model for the male transobturator sling

  • Urology - Original Paper
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Abstract

Introduction and objectives

Urodynamic studies are often performed in the evaluation of post-prostatectomy urinary incontinence (PPUI). The male transobturator sling (TOS) is a minimally invasive treatment for PPUI. Others have reported their results with a specific Valsalva leak point pressure (VLPP) that predicts a good outcome with the male TOS. Our objective was to determine the relationship of the pre-operative VLPP on the success rate of the male TOS in a high-volume, single center. We hypothesized that a higher pre-operative VLPP better predicts successful outcomes.

Methods

We reviewed patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent TOS placement were identified using our patient data portal (DEDUCE). Demographic, urodynamic, and follow-up data were extracted by chart review. Post-operative success was defined by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g per 24 h. Cox and linear regression models were performed.

Results

290 patients were included. All patients underwent a radical prostatectomy for prostate cancer and presented with PPUI. Mean age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5 months (IQR 1–15). A linear regression model shows an inverse prediction curve for sling failure versus VLPP (p = 0.02). The hazard ratio for failure with a VLPP of ≤ 70 cm H2O compared with a VLPP of > 70 cm H2O, adjusted for pelvic radiation and 24-h pad weight was 0.5 (95% CI 0.2–0.98).

Conclusion

Patient selection is imperative in the success of the male TOS for patients with PPUI. In our cohort of patients with PPUI, those with a pre-procedural VLPP of > 70 cm H2O were 50% less likely to fail after TOS placement versus those with a VLPP ≤ 70 cm H2O. In our practice, we use these data to support the use of VLPP cut off of 70 cm H2O as an indicator for success to help in the evaluation and counseling of patients.

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Abbreviations

TOS:

Transobturator sling

VLPP:

Valsalva leak point pressure

PPUI:

Post-prostatectomy urinary incontinence

IQR:

Interquartile range

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Authors and Affiliations

  1. Department of Urology, University of Rochester Medical Center, 601 Elmwood Drive, Rochester, NY, 14602, USA

    Divya Ajay

  2. Department of Urology, The University of Adelaide, Adelaide, SA, Australia

    Arman A. Kahokehr

  3. Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Aaron C. Lentz & Andrew C. Peterson

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  1. Divya Ajay
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  2. Arman A. Kahokehr
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  3. Aaron C. Lentz
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  4. Andrew C. Peterson
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Correspondence to Divya Ajay.

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Divya Ajay—none. Arman A. Kahokehr—none. Aaron C. Lentz—Consultant Boston Scientific and Coloplast. Andrew C. Peterson—consultant Boston Scientific.

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Ajay, D., Kahokehr, A.A., Lentz, A.C. et al. Valsalva leak point pressure (VLPP) greater than 70 cm H2O is an indicator for sling success: a success prediction model for the male transobturator sling. Int Urol Nephrol 54, 1499–1503 (2022). https://doi.org/10.1007/s11255-022-03222-4

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