Predictive value of stress cough test after the treatment with tension-free vaginal tape

Kasvan G.R.. Pushkar D.Y.
Moscow State University of Medicine and Dentistry, Dept. of Urology, Moscow, Russia

Introduction & Objectives:
The stress cough test is a useful and objective test in evaluating the outcomes of SUI surgery. It is widely accepted by physicians because it is less time-consuming than the 24-hour pad test and because it can easily become a part of the routine physical examination on follow-up visits. However, there is still no consensus on the minimal follow-up period that is required before the results of this test become valid. In our study we compared the cough test results of patients at the short- and long-term follow-up appointments.

Materials & Methods:
The study included women with stress urinary incontinence that underwent surgical treatment with retropubic or transobturator tension-free tapes. All patients have got routine clinical examination within one month of surgery. Starting in June 2008, patients were contacted again via mail or telephone, and, when available, were invited for additional follow-up visits. During both follow-up visits, patients underwent thorough physical and vaginal examinations along with cough stress tests (150 normal saline in the bladder), uroflowmetry, and post-void residual urine volume measurement.

Results:
Overall, 377 women who underwent TVT (166) or TVT-0 (211) were analysed with cough test. The mean follow-up time of the patients in Group 1 and Group 2 were51.1±7.6 months and 30.1±3.0 months, respectively. We did not find any significant difference in cough test between patients in Group 1 (85.58%) and Group 2 (84.36%) with a longer follow up period (p-0.868).We found that 90.86% of patients who had a negative cough test within 1 month after surgery remained dry on a cough test during long-term follow up. Our study showed that 85.19% of the patients who leaked urine during the 1-month cough test still had a positive cough test at their long-term follow-up appointments. Only 14.81 % of women who leaked urine during their initial cough test ultimately improved. Statistical analysis demonstrated that the results of the one-month cough test for female patients treated with TVT remained the same with a longer follow-up time period (p=0.000).

Table 1. Predictive value of cough test

  Negative cough test - more than 12 months after surgery Positive cough - more than 12 months after surgery p-value for Fisher exact test, two-tailed
Negative cough test within 1 months after surgery 318 pts (90.86%) 32 pts (9.14%) 0.000
Positive cough test within 1 month after surgery 4 pts (14.81%) 23 pts (85.19%)  

Conclusions:
According to our analysis, the results of a cough test performed within one month after surgery has a high probability of remaining the same upon prolonged observation.

Download

Download article