Preoperative Urodynamic Parameters (VLPP and MUCP), Urinary N-Telopeptide (NTx), and Plasma Vitamin D Levels as Predictors of Midurethral Sling Surgery Outcome Journal Article

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Authors: Chai, T. C.; Moalli, P. A.; Richter, H. E.; Lake, A. G.; Kim, H. Y.; Nager, C. W.; Sirls, L. T.; Brubaker, L; Kusek, J. W.
Article Title: Preoperative Urodynamic Parameters (VLPP and MUCP), Urinary N-Telopeptide (NTx), and Plasma Vitamin D Levels as Predictors of Midurethral Sling Surgery Outcome
Abstract: PURPOSE: To determine the best predictor for MUS outcome, area under the curve (AUC) values from receiver operator characteristics (ROC) curves were calculated for these preoperative parameters: Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urinary NTx, and plasma vitamin D values (D2, D3, and D2+D3). MATERIALS AND METHODS: This was an ancillary study of two trials (TOMUS and ValUE) in which subjects underwent MUS surgery for stress urinary incontinence (SUI). VLPP and MUCP were measured in 427 subjects, whereas NTx, vitamin D2, vitamin D3, and vitamin D2+D3 levels were obtained from 150, 116, 115, and 116 subjects respectively. Outcome "success" was defined using identical outcome (subjective and objective) variables for all subjects. ROC curves with corresponding AUC values were compared. RESULTS: TOMUS and ValUE subjects were significantly different in age, body mass index, UDI (Urogenital Distress Inventory) scores. TOMUS subjects had a lower surgical success rate compared to ValUE subjects (66.3% versus 76.0%, p=0.03). AUC values for VLPP, MUCP, NTx, vitamin D2, D3 and D2+D3 were 0.542, 0.561 and 0.702, 0.627, 0.645, and 0.640, AUC value for NTx being significantly higher than for VLPP and MUCP (p=0.02 and 0.03, respectively). CONCLUSIONS: Urinary NTx was the best predictor for MUS outcome. Not only is this test non-invasive, it is also modifiable. Finding ideal modifiable risk factors prior to MUS should be subject to future investigations.
Journal Title: The Journal of urology
ISSN: 1527-3792; 0022-5347
Publisher: Unknown  
Date Published: 2016
Language: ENG
DOI/URL:

S0022-5347(16)30280-4
Notes: LR: 20160427; CI: Copyright (c) 2016; JID: 0376374; OTO: NOTNLM; 2016/03/06 [accepted]; aheadofprint