Tweetable abstract
The bladder developed an elevated pressure gradient to the TOT-enhanced
outlet resistance; and herein enhanced the voiding efficacy.
This study was registered in ClinicalTrials.gov (NCT05255289)
INTRODUCTION
Weakness in muscle and/or tissue surrounding the urethra results in
stress urinary incontinence (SUI) characterized by involuntary urine
leakage on effort, physical exertion, sneezing, or
coughing.1 SUI is a common problem affecting women’s
daily life in physical, social, and hygienic aspects.2Conservative options, such as strengthening of the pelvic floor
musculature3 and bladder training,4are prescribed for SUI patients; and for those who have failed
conservative therapies, a mid-urethral sling is a preferred treatment
recommended.5 In 1996, the first mid-urethral sling,
tension-free vaginal tape, was launched;6 and
subsequently, the trans-obturator tape (TOT) was developed in
2001.7 For TOT exhibits a satisfied cure rate and a
relatively diminishes invasiveness,8,9 it is
increasingly accepted as a treatment of choice worldwide in the last
decade.10
The procedure of TOT positions a narrow band of synthetic tape under the
urethra;11 and together with the scar tissue that
grows following the sling implantation, the tape adds-on an exogenous
urethra resistance to maintain the continence during urine
storage.12 Notably, in contrast to the well-recognized
therapeutic benefit of the enhanced resistance to the bladder continence
during urine storage,13 if the voiding function of the
bladder adapts to the TOT-enhanced outlet resistance has not been
adequately investigated.14-16 Particularly, to the
best knowledge of ours, there is so far no study exploring if the
thermodynamic efficacy of the bladder is modified following the TOT.
Because an insufficient work output in response to an enhanced loading
caused by the TOT-enhanced resistance could be a risk factor leading to
un-compensated bladder functions,17 we investigated
the change in the thermodynamic efficacy of the bladder in response to
the TOT to clarify the potential adaptation of the bladder to the
enhanced outlet resistance.
Interestingly, a recent study demonstrated the pressure-volume analysis
(PVA) of voiding cycles specifically assays the voiding work of the
bladder and thereby quantifies the thermodynamic efficacy of bladder
emptying.18 We hence explored the potential
modifications in the thermodynamic efficacy of the bladder in response
to the TOT using the PVA.