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Intraoperative Crede maneuver for tape adjustment during transobturator sling placement: does it improve continence?
Female Pelvic Med Reconstr Surg. 2013 Nov-Dec; 19(6):369-73.FP

Abstract

OBJECTIVE

This study evaluated the efficacy of intraoperative extrinsic manual compression on the bladder, or Crede maneuver (CM) for tape adjustment during transobturator tape (TOT) sling procedure versus the traditional method where tension-free tape is adjusted the same for all patients.

METHODS

All patients undergoing TOT sling procedure for stress urinary incontinence (SUI) between May 2008 and June 2011 by the first author were assessed. Tape adjustment was either performed in a traditional manner, leaving a tonsil clamp-size space between the sling and posterior urethra, or by using CM after filling the bladder to 300 ml capacity. Patients were considered cured at postoperative visits if they had no SUI symptoms and negative Cough Stress Test (CST) result, improved if they had some SUI symptoms and negative CST result, and failed if symptomatic and had positive CST result. The Fisher exact test and the Wilcoxon rank sum test were used to evaluate the baseline differences between the 2 groups, along with multiple logistic regression to evaluate independent predictors of cure.

RESULTS

The continence rate was 77.67% in the traditional group (87/112) and 79.65% (137/172) in the CM group (P = 0.76). Older patients and smokers were less likely to be continent (odds ratio, 0.95; P = 0.015; and odds ratio, 0.22; P = 0.003, respectively). Five (4.5%) of the 112 patients in the traditional group and 12 (6.9%) of the 172 patients in the CM group had adverse outcomes including transient urinary retention, mesh erosion, or dysuria (P = 0.45).

CONCLUSION

Using CM for intraoperative tape adjustment does not improve continence rates compared to the traditional method of TOT sling placement.

Authors+Show Affiliations

From the Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24165452

Citation

Lazarou, George, et al. "Intraoperative Crede Maneuver for Tape Adjustment During Transobturator Sling Placement: Does It Improve Continence?" Female Pelvic Medicine & Reconstructive Surgery, vol. 19, no. 6, 2013, pp. 369-73.
Lazarou G, Miller C, Gupta N, et al. Intraoperative Crede maneuver for tape adjustment during transobturator sling placement: does it improve continence? Female Pelvic Med Reconstr Surg. 2013;19(6):369-73.
Lazarou, G., Miller, C., Gupta, N., Islam, S., & Vetere, P. (2013). Intraoperative Crede maneuver for tape adjustment during transobturator sling placement: does it improve continence? Female Pelvic Medicine & Reconstructive Surgery, 19(6), 369-73. https://doi.org/10.1097/SPV.0000000000000034
Lazarou G, et al. Intraoperative Crede Maneuver for Tape Adjustment During Transobturator Sling Placement: Does It Improve Continence. Female Pelvic Med Reconstr Surg. 2013 Nov-Dec;19(6):369-73. PubMed PMID: 24165452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative Crede maneuver for tape adjustment during transobturator sling placement: does it improve continence? AU - Lazarou,George, AU - Miller,Corrie, AU - Gupta,Neetu, AU - Islam,Shahidul, AU - Vetere,Peter, PY - 2013/10/30/entrez PY - 2013/10/30/pubmed PY - 2013/12/18/medline SP - 369 EP - 73 JF - Female pelvic medicine & reconstructive surgery JO - Female Pelvic Med Reconstr Surg VL - 19 IS - 6 N2 - OBJECTIVE: This study evaluated the efficacy of intraoperative extrinsic manual compression on the bladder, or Crede maneuver (CM) for tape adjustment during transobturator tape (TOT) sling procedure versus the traditional method where tension-free tape is adjusted the same for all patients. METHODS: All patients undergoing TOT sling procedure for stress urinary incontinence (SUI) between May 2008 and June 2011 by the first author were assessed. Tape adjustment was either performed in a traditional manner, leaving a tonsil clamp-size space between the sling and posterior urethra, or by using CM after filling the bladder to 300 ml capacity. Patients were considered cured at postoperative visits if they had no SUI symptoms and negative Cough Stress Test (CST) result, improved if they had some SUI symptoms and negative CST result, and failed if symptomatic and had positive CST result. The Fisher exact test and the Wilcoxon rank sum test were used to evaluate the baseline differences between the 2 groups, along with multiple logistic regression to evaluate independent predictors of cure. RESULTS: The continence rate was 77.67% in the traditional group (87/112) and 79.65% (137/172) in the CM group (P = 0.76). Older patients and smokers were less likely to be continent (odds ratio, 0.95; P = 0.015; and odds ratio, 0.22; P = 0.003, respectively). Five (4.5%) of the 112 patients in the traditional group and 12 (6.9%) of the 172 patients in the CM group had adverse outcomes including transient urinary retention, mesh erosion, or dysuria (P = 0.45). CONCLUSION: Using CM for intraoperative tape adjustment does not improve continence rates compared to the traditional method of TOT sling placement. SN - 2151-8378 UR - https://www.unboundmedicine.com/medline/citation/24165452/Intraoperative_Crede_maneuver_for_tape_adjustment_during_transobturator_sling_placement:_does_it_improve_continence L2 - https://doi.org/10.1097/SPV.0000000000000034 DB - PRIME DP - Unbound Medicine ER -