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Intraoperative Crede Maneuver for Tape Adjustment During Transobturator Sling Placement: Does It Improve Continence?

Lazarou, George MD, FACOG, FACS; Miller, Corrie DO; Gupta, Neetu MD; Islam, Shahidul MPH, CPH; Vetere, Peter MD, FACOG, FACS

Female Pelvic Medicine & Reconstructive Surgery: November/December 2013 - Volume 19 - Issue 6 - p 369–373
doi: 10.1097/SPV.0000000000000034
Original Articles
Journal Club
Journal Club Q and A

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.

Using Crede maneuver for intraoperative tape adjustment does not improve continence rates compared to the traditional method of transobturator tape sling placement.

From the Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY.

Reprints: George Lazarou, MD, FACOG, FACS, Urogynecology and Reconstructive Pelvic Surgery, Winthrop-University Hospital; and Department of Obstetrics, Gynecology and Women’s Health, Stony Brook University Hospital, 259 First St, Mineola, NY 11501. E-mail:

The authors have declared they have no conflicts of interest.

The authors have no relevant financial disclosures.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.