RELIABILITY AND CORRELATION OF MEASUREMENTS DURING AND AFTER BLADDER NECK-SURGERY

Objectives To assess the reliability of seven intraoperative measureme nts of the effects of bladder neck suspension and correlate these meas urements with postoperative dynamic urethral obstruction, quantified a s the cough-pressure transmission ratio. Patients and methods Sixty wo men undergoing surgery for bladder neck hypermobility had seven measur ements performed in duplicate: (i) the endoscopic appearance of the bl adder neck: (ii) the bladder neck-retropubic surface distance (BN-RP d istance); (iii) urethral axis; (iv) slow urethral pressure profilometr y (UPP); (v) fast UPP; (vi) straining UPP; and (vii) dynamic UPP. Reli abilities were assessed by computing the intraclass correlation coeffi cient (R) for continuous data or Kappa statistic (K) for ordinal data. Pearson correlation coefficients were used to assess the relationship s between the intra-operative measures and postoperative pressure tran smission. Results The intra-operative reliabilities for maximum pressu re, 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=0.15-0.3 3), BN-RP distance (R=0.55), and endoscopic appearance (K=0.10). There were significant correlations of the pressures from the UPPs and intr a-operative pressure transmission ratios with postoperative pressure t ransmission ratios; however, the poor intra-operative reliability of i ntra-operative pressure transmission limits their usefulness. None of the other measures correlated significantly with postoperative pressur e transmission ratios. Conclusions Of the measures studied, only intra operative UPPs had both high reliability and good postoperative correl ations.