Urodynamic and urethral pressure profilometry findings in women with voiding phase dysfunction treated with surgical urethrolysis

Abstract

Introduction: Long-term urodynamic (UDS) and urethral pressure profilometry (UPP) parameters in women with voiding phase dysfunction following an anti-incontinence (AI) procedure have been poorly characterized. We report our 10-year UDS findings in women with voiding phase dysfunction after AI procedure, who underwent urethrolysis. Methods: We identified sequential records containing urethrolysis CPT codes over a 10-year period. Records of women with preoperative UDS were reviewed for demographics, UDS tracing, and outcomes following urethrolysis. Results: Twenty-five women (mean age 60 years) had voiding phase dysfunction and underwent urethrolysis at a mean of 47 months (interquartile range [IQR] 12–61) after AI procedure. Preoperatively, six (24%) women required intermittent catheterization. Free uroflowmetry revealed a mean: maximum peak flow (Qmax) 9.6 ml/s (IQR 7.0–11.0), voided volume 137 ml (IQR 81–169), and postvoid residual 167 ml (IQR 43–288). UDS revealed a mean: UPP length 24 mm (IQR 20–27), UPP closure pressure 78 cmH2O (IQR 59–103), Pdet@Qmax 31 cmH2O (IQR 19–43), Qmax 7.9 ml/s (IQR 5.0–12.0), bladder outlet obstruction index 15 (IQR 0–34), and bladder contractility index 71 (IQR 60–81). UPP length was significantly associated (Pearson correlation, p<0.05) with: bladder outlet obstruction index (r=0.80), Pdet@Qmax (r=0.75), and time since AI procedure (r=-0.70). UPP closure pressure was significantly associated with age (r=-0.64), volume of first (r=-0.64) and strong (r=-0.78) desire, and capacity (r=-0.71). Following urethrolysis, spontaneous voiding was achieved in 23 (92%) women at followup (mean 308 days). Conclusions: UPP may help characterize outlet parameters in women with voiding phase dysfunction following an AI procedure, who ultimately undergo urethrolysis.