Marker may predict midurethral sling outcomes

A marker of collagen turnover proved to be the most predictive test for outcome after midurethral sling procedures, the authors of a multicenter study reported.

N-terminal telopeptide of cross-linked type 1 collagen (NTx) was associated with an area under the receiver operating characteristic curve (AUC) of 0.702, which was significantly better than the Valsalva leak point pressure (VLPP) or maximum urethral closing pressure (MUCP).

“This initial foray into looking at biomarkers for disease additionally followed as an anatomic problem that can be fixed with a sling suggests that there is a biological signal that can allow us to intervene possibly in a neoadjuvant way at the time of surgery to increase our success rate,” said study co-author Toby Chai, MD, of Yale School of Medicine, New Haven, CT.

The findings came from a study designed to create receiver operating characteristic (ROC) curves for preoperative VLPP, MUCP, and NTx as predictors of midurethral sling outcomes. Secondarily, Dr. Chai and colleagues wanted to determine which preoperative variable best predicts sling outcomes.

The analysis involved 577 patients from two clinical trials, one of which had preoperative urinary NTx values and the other preoperative VLPP and MUCP values. Successful outcome was defined as a 70% decrease in the Urogenital Distress Inventory, a score of 1 or 2 on the Patient Global Impression of Improvement, and a negative 300 cc bladder volume stress test.

By AUC values, NTx performed significantly better than VLPP (AUC: 0.542, p=0.02) and MUCP (AUC: 0.561, p=.03).

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