Preoperative voiding detrusor pressures do not predict stress incontinence surgery outcomes (original) (raw)
Related papers
International Urogynecology Journal, 2012
Introduction and hypothesis The aim of this study was to determine whether preoperative voiding detrusor pressures were associated with postoperative outcomes after stress incontinence surgery. Methods Opening detrusor pressure, detrusor pressure at maximum flow (p det Q max), and closing detrusor pressure were assessed from 280 valid preoperative urodynamic studies in subjects without advanced prolapse from a multicenter randomized trial comparing Burch and autologous fascia sling procedures. These pressures were compared between subjects with and without overall success, stress-specific success, postoperative detrusor overactivity, and postoperative urge incontinence using independent sample t tests. Results There were no clinically or statistically significant differences in mean preoperative voiding detrusor pressures in any comparison of postoperative outcomes. Conclusions We found no evidence that preoperative voiding detrusor pressures predict outcomes in women with stress predominant urinary incontinence undergoing Burch or autologous fascial sling procedures.
The Journal of Urology, 2008
We determined the prognostic value of preoperative urodynamic results in patients with stress urinary incontinence. Materials and Methods: In a 9-center surgical trial, women with stress urinary incontinence were randomized to a Burch or pubovaginal sling procedure. Women were eligible for the study if they had predominant stress urinary incontinence symptoms, a positive cough stress test, a bladder capacity more than 200 ml and urethral hypermobility. Preoperative free uroflowmetry, filling cystometry and pressure flow studies were performed in all. Overall treatment success required a negative pad test, no urinary incontinence on a 3-day diary, a negative stress test, no self-reported stress urinary incontinence symptoms and no re-treatment for stress urinary incontinence. Stress specific success required all of the last 3 criteria. We examined urodynamic measures, and whether the presence of urodynamic stress incontinence, the presence of detrusor overactivity and Valsalva leak point pressure would predict surgical success. Results: Subjects with urodynamic stress incontinence had a 2-fold greater odds of overall success when compared with the No urodynamic stress incontinence group, but this trend did not quite reach statistical significance (OR 2.26; 95% C.I. 0.99, 5.17). Odds of stress specific success did not differ by urodynamic stress incontinence status. Subjects with detrusor overactivity did not have significantly worse success rates. Stratifying by treatment group, there was no difference in mean Valsalva leak point pressure values between surgical successes and failures. Conclusions: We found a nearly statistically significant trend that women with urodynamic stress incontinence are twice as likely to have a successful overall outcome from surgical management of stress urinary incontinence as women without urodynamic stress incontinence. The level of Valsalva leak point pressure and the presence of detrusor overactivity do not predict the success outcomes after the Burch or autologous fascia sling procedures in women with pure or predominant stress urinary incontinence. The impact of urodynamic studies on surgical outcomes needs further investigation.
International Urogynecology Journal, 2008
The aim of this study was to correlate the lowest Valsalva or cough leak point pressure (LPP) with clinical measures of incontinence severity and quality of life in women with pure urodynamic stress incontinence (SUI). This is an analysis of the baseline data from a prospective, multicenter, randomized trial comparing the Monarc transobturator sling to the tension-free vaginal tape. One hundred fifty-five women with SUI underwent urodynamic evaluations including abdominal or vesical LPP determinations, and each completed the Sandvik Incontinence Severity Index, a 3-day voiding diary, and quality-of-life questionnaires. In patients with a LPP, there were no significant correlations between LPP and the above clinical measures of incontinence severity or condition-specific quality-of-life questionnaire scores. In this patient population with pure urodynamic SUI, LPP is not a useful urodynamic predictor of baseline SUI severity and its effects on quality of life.
Journal of King Abdulaziz University - Medical Sciences
The aim of our study was to determine the effect of preoperative urodynamic reading of valsalva leak point pressure on the result of mid-urethral sling surgery. From January 2010 to December 2014, a total of 207 patients underwent mid-urethral sling surgery at the Toronto Western Hospital. An incontinence questionnaire was sent to 94 patients who accepted to be involved in the study to examine satisfaction post-surgery. Forty-five patients replied and were included in the analysis. The patients were divided into three groups according to valsalva leak point pressure (< 60, 60-80 and > 80 cm H2O) determined on urodynamic testing. Of the forty-five patients who responded to the questionnaire, seven were excluded for only having had stress testing done and two were excluded due to intermittent catheterization. Thirteen patients had evidence of detrusor overactivity on urodynamic testing. Simple linear regression analysis was done for the three groups of the valsalva leak point pr...
International Journal of Urology, 2003
Background : The aim was to compare the efficacy of Burch colposuspension, transvaginal fourcorner bladder neck suspension (FCBNS) and the vaginal wall sling (VWS) procedures in patients with stress urinary incontinence. Methods : A retrospective analysis was performed on 88 patients who underwent Burch colposuspension ( n = 20), FCBNS ( n = 29) and VWS ( n = 39) for stress urinary incontinence. Objective and subjective cure rates at 3 months and annually after the operation were the primary outcome measures. Results : The patients were similar in age, parity, menopausal status, grade of cystocel and preoperative residual urine volumes. Fourteen out of 20 (70%) patients showed improvement in the group undergoing Burch colposuspension, 29 out of 39 (74.4%) patients showed improvement in the FCBNS group, and 28 out of 29 (96.6%) patients showed improvement in the VWS group. The mean length of follow up was 3.8 years (range 3-5). Conclusion : In this study, the VWS procedure had a higher long-term cure rate of stress urinary incontinence when compared with the Burch colposuspension and the FCBNS procedures.
The Journal of Urology, 2009
We determined the clinicodemographic factors associated with complications of continence procedures, the impact of concomitant surgery on the complication rate and the relationship between the incidence of cystitis and the method of postoperative bladder drainage. Materials and Methods: We reviewed serious adverse events and adverse events in the Stress Incontinence Surgical Efficacy Trial, a randomized trial comparing Burch colposuspension to the autologous rectus fascial sling. Clinicodemographic variables were analyzed to determine those associated with adverse events using logistic regression analysis. Complications were stratified based on the presence or absence of concomitant surgery. Differences in complication rates (controlling for concomitant surgery) and cystitis rates (controlling for the bladder emptying method) were compared using Fisher's exact test. Results: Blood loss (p ϭ 0.0002) and operative time (p Ͻ0.0001) were significantly associated with an adverse event. Patients who underwent concomitant surgery had a significantly higher serious adverse event rate (14.2% vs 7.3%, p ϭ 0.01) and adverse event rate (60.5% vs 48%, p Ͻ0.01) than patients who underwent continence surgery alone. Cystitis rates were higher in the sling vs the Burch group up to 6 weeks postoperatively regardless of concomitant surgery status (p Ͻ0.01). Intermittent self-catheterization increased the cystitis rate by 17% and 23% in the Burch and sling groups, respectively. Conclusions: Concomitant surgery at continence surgery increased the risk of complications. Sling surgery was associated with a higher risk of cystitis within the first 6 weeks postoperatively. Intermittent self-catheterization increased the risk of cystitis in each group. Complications were associated with surgical factors and not with patient related factors.
Urodynamics before stress urinary incontinence surgery
Current opinion in obstetrics & gynecology, 2014
In patients with symptoms of stress urinary incontinence, there is still a debate regarding the benefit of a multichannel urodynamic investigation prior to surgical management. The purpose of this article is to review recent evidence on this topic. Results of two large randomized controlled trials provided evidence that preoperative urodynamics do not improve outcome of incontinence surgery in women with uncomplicated stress urinary incontinence. Furthermore, in this selected group of women, urodynamics hardly lead to deviation of surgery as a primary treatment in case of an indication for operation based on symptoms and signs. Low urethral closure pressures and detrusor overactivity are urodynamic parameters which were associated with impaired cure of symptoms of stress urinary incontinence after surgery. Preoperative urodynamics do not improve outcome in women with complaints of stress incontinence and do hardly alter the treatment plan. It remains questionable whether a more accu...
Value of Urodynamics Before Stress Urinary Incontinence Surgery
Obstetrical & Gynecological Survey, 2013
using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. Results.dIn total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 V. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 V/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 V/QALY). The cost-effectiveness was 106.5 V/International Consultation Incontinence Questionnaire Short-form unit. Conclusion.dSurgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.