Reliability and correlation of measurements during and after bladder neck surgery

• Published in: British Journal of Urology Vol. 82; no. 5; pp. 628 - 633
• Main Authors: BUMP, R. C, HURT, W. G, ADDISON, W. A, FANTL, J. A, MCCLISH, D. K
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-11-1998; Blackwell
• Subjects: Biological and medical sciences; continence surgery; intra‐operative monitoring; Medical sciences; Prolapse surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Performance evaluation; Human; Postoperative; Urinary system disease; Exploration; Urinary tract disease; Voiding dysfunction; Surgical suspension; Treatment; Surgery; Morphology; Female; Bladder disease; Bladder neck; Preoperative; Urinary stress incontinence; Internal pressure
• ISSN: 0007-1331; 1464-410X
• DOI: 10.1046/j.1464-410x.1998.00825.x

Objectives
 To assess the reliability of seven intra‐operative measurements of the effects of bladder neck suspension and correlate these measurements with postoperative dynamic urethral obstruction, quantified as the cough‐pressure transmission ratio.
Patients and methods
 Sixty women undergoing surgery for bladder neck hypermobility had seven measurements performed in duplicate: (i) the endoscopic appearance of the bladder neck: (ii) the bladder neck‐retropubic surface distance (BN‐RP distance); (iii) urethral axis; (iv) slow urethral pressure profilometry (UPP); (v) fast UPP; (vi) straining UPP; and (vii) dynamic UPP. Reliabilities were assessed by computing the intraclass correlation coefficient (R) for continuous data or Kappa statistic (K) for ordinal data. Pearson correlation coefficients were used to assess the relationships between the intra‐operative measures and postoperative pressure transmission.
Results
 The intra‐operative reliabilities for maximum pressure, length and area from the three UPP techniques were high (R=0.88–0.98) as were those for urethral axis measurements (R=0.98). In contrast, reliabilities were poor for pressure transmission ratios (R=0.15–0.33), BN‐RP distance (R=0.55), and endoscopic appearance (K=0.10). There were significant correlations of the pressures from the UPPs and intra‐operative pressure transmission ratios with postoperative pressure transmission ratios; however, the poor intra‐operative reliability of intra‐operative pressure transmission limits their usefulness. None of the other measures correlated significantly with postoperative pressure transmission ratios.
Conclusions
 Of the measures studied, only intra‐operative UPPs had both high reliability and good postoperative correlations.