PURPOSE: Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes. MATERIALS AND METHODS:Patients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/orValsalva leak point pressure [VLPP]<60 cm H2O and/or maximum urethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively. RESULTS:A total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the "urodynamic testing" and "office evaluation only" groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes). CONCLUSIONS: Our findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions.
RCT Entities:
PURPOSE: Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes. MATERIALS AND METHODS:Patients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/or Valsalva leak point pressure [VLPP]<60 cm H2O and/or maximum urethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively. RESULTS: A total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the "urodynamic testing" and "office evaluation only" groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes). CONCLUSIONS: Our findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions.
Authors: Werner Schäfer; Paul Abrams; Limin Liao; Anders Mattiasson; Francesco Pesce; Anders Spangberg; Arthur M Sterling; Norman R Zinner; Philip van Kerrebroeck Journal: Neurourol Urodyn Date: 2002 Impact factor: 2.696
Authors: R Marijn Houwert; Pieter L Venema; Annelies E Aquarius; Hein W Bruinse; Jan Paul W R Roovers; Harry A M Vervest Journal: Am J Obstet Gynecol Date: 2009-06-26 Impact factor: 8.661
Authors: Tondalaya L Gamble; Sylvia M Botros; Jennifer L Beaumont; Roger P Goldberg; Jay-James R Miller; Oyinlolu Adeyanju; Peter K Sand Journal: Am J Obstet Gynecol Date: 2008-10-09 Impact factor: 8.661
Authors: R Marijn Houwert; Pieter L Venema; Annelies E Aquarius; Hein W Bruinse; Paul J M Kil; Harry A M Vervest Journal: Am J Obstet Gynecol Date: 2009-04-03 Impact factor: 8.661
Authors: Nicolas S Bodmer; Carla Wirth; Veronika Birkhäuser; Andrea M Sartori; Lorenz Leitner; Marcio A Averbeck; Stefan de Wachter; Enrico Finazzi Agro; Andrew Gammie; Howard B Goldman; Ruth Kirschner-Hermanns; Peter F W M Rosier; Maurizio Serati; Eskinder Solomon; Gommert van Koeveringe; Lucas M Bachmann; Thomas M Kessler Journal: Eur Urol Open Sci Date: 2022-09-05