Maximum urethral closure pressure (MUCP) is a means of trying to provide an objective assessment of urethral integrity. In some centres it is used as a tool to help predict outcomes after mid-urethral sling (MUS) placement. The authors propose that a low urethral closure pressure may be associated with poor outcomes following MUS surgery. This retrospective study involved 236 women, identified from the British Society of Urogynaecology (BSUG) database, who underwent MUS surgery over a five-year period. MUCP was recorded at the time of urodynamics, and surgical outcomes were measured using the Patient Global Impression of Improvement (PGII) and the Urinary Incontinence Quality of Life Questionnaire (ICIQ-SF). Patients were then followed up by telephone by a nurse specialist. Patients who recorded their surgical outcome as “no improvement”, “worse” or “much worse” were identified as having a poor outcome whereas if patients reported “a little improvement”, “improved” and “very much improved” they were recorded as having a good outcome. In total 24 (10.2%) of patients had a poor outcome. When the poor and good outcome groups were compared the only difference was a significantly lower MUCP in the poor outcome group (p=0.005). The study concludes that this has implications for the investigation and treatment for women with stress incontinence and that it is time to reconsider the assessment of MUCP before surgery to aid in informed consent.

Should maximal urethral closure pressure be performed before mid-urethral sling surgery for stress incontinence? A time to revisit.
Vij M, Dua A, Freeman RM.
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Ann Crump

Central Manchester Foundation NHS Trust

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