The role of maximal urethral closure pressure in predicting the outcomes of trans-obturator tape operation

Published:January 23, 2023DOI:



      To investigate the role of preoperative maximal urethral closure pressure (MUCP) in predicting postoperative outcomes of trans-obturator tape (TOT) operation.

      Study design

      82 patients who underwent TOT surgery due to urodynamically proven stress urinary incontinence were retrospectively analyzed. Preoperative and 6th month postoperative results of cough stress tests (CST), Turkish validated Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) quality of life (QOL) questionnaires were recorded. Patients who had negative CST and more than 50% improvement in the QOL questionnaires in the postoperative evaluation were classified as cured.


      14 (17.1 %) patients had MUCP ≤ 20 cmH2O, 68 (83 %) patients had MUCP > 20 cmH2O. The postoperative IIQ-7 and UDI-6 QOL scores were significantly improved compared to preoperative values in both MUCP ≤ 20 cmH2O and MUCP > 20 cmH2O groups. However, cure rate was lower in the MUCP ≤ 20 cmH2O group than in MUCP > 20 cmH2O group (35.7 % vs 83.8 %, respectively). Preoperative MUCP measurement and urethral mobility assessment were found to be independent factors associated with surgical outcome. A preoperative MUCP ≥ 28.5 cmH2O could predict surgical success after TOT with 92.6 % sensitivity and 85.7 % specificity.


      TOT is a reliable method that has a high efficacy in the surgical treatment of stress urinary incontinence in short-term. Patients with low MUCP can also benefit from TOT. However, the success rate of TOT surgery decreases in the presence of low MUCP and absence of hypermobile urethra.


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      Mahmut Kuntay Kokanali is a senior surgeon who primarily works in the field of urogynecology, reproductive endocrinology and endoscopic surgery. He has been involved in more than 50 studies in gynecology literature. He works as an associate professor in a training and research hospital.


      Fatih Aktoz is a young surgeon and investigator who primarily works in the field of minimally invasive gynecology. He has written several studies and book chapters in the field of obstetrics and gynecology.


      Orhan Seyfi Aksakal is a senior surgeon who primarily works in the field of urogynecology. He has invented various patented surgical instruments. He works as a professor in a training and research hospital.