Feasibility of measuring urethral pressure during female midurethral slings: Case report

Abstract

Rationale:Stress urinary incontinence (SUI) refers to the involuntary leakage of urine when abdominal pressure increases. Midurethral slings (MUS) have become the main surgical method for treating SUI, but no quantitative standard for the degree of sling tightness during operation exists. We achieved this quantitative measurement using ambulatory urodynamic equipment.Patient concerns:A 49-year-old woman presented to our hospital with intermittent urine leakage. Five pads were used daily to keep the vulva dry. The preoperative urethral pressure profilometry (UPP) showed that maximum urethral pressure (MUP) was 54cmH2O and maximum urethral closure pressure (MUCP) was 53cmH2O.Diagnosis:According to the medical history and examination findings, the patient was diagnosed as SUI.Interventions:The MUS and UPP were performed.Outcomes:The intraoperative UPP showed that MUP was 29cmH2O and MUCP was 17cmH2O. Three months after the operation, the patient was followed up by telephone. The amount of urine pad usage decreased from 5pads/d to 0pads/d, reaching the social control standard (0-1pads/d). The patient's international consultation on incontinence questionnaire short form score decreased from 18 to 5, and their incontinence quality of life score increased from 12.5 to 78.4. The effect of urine control was satisfactory, and no complications occurred.Five months after operation, the patient was reexamined in the outpatient department. The UPP showed that the MUP was 98cmH2O and the MUCP was 72cmH2O. The patient still uses 1pad/day. The international consultation on incontinence questionnaire short form score is 6 and incontinence quality of life score is 79.5. The curative effect is stable.Lessons:MUS has become an effective surgical method for SUI, and the tightness of the sling directly affects the surgical outcome. We have achieved the measurement of urethral pressure during MUS. However, although we found that there is no obvious clinical significance of urethral pressure measurement in MUS operation, future research will benefit from our findings by improving upon our study design to help standardize the clinical diagnosis and treatment of MUS.