Urodynamics criteria of detrusor underactivity in women underwent middle urethral sling for stress urinary incontinence: What is the clinical role?

Is detrusor underactivity associated with voiding dysfunction after single incision sling surgery?

BACKGROUND

Some women experience voiding dysfunction after stress urinary incontinence (SUI) surgery. We explore if detrusor underactivity (DU) found in urodynamic study (UDS) prior to SUI surgery using an adjustable single incision sling (SIS) may be related to voiding dysfunction after surgery.

METHODS

This is a prospective, diagnostic, transversal, single center study comparing voiding dysfunction after SUI surgery with a SIS (Altis®; Coloplast, Humlebæk, Denmark) between women with DU (cases) or normal detrusor (controls). Inclusion criterium was women ≥18 years with SUI/mixed UI (stress predominant) operated between June 2013 and December 2020. Exclusion criteria were: women without UDS prior to surgery or without voiding phase in the P/Q, previous incontinence surgery, POP stage ≥2, neurogenic conditions, other pelvic floor surgery. Urinary symptoms were assessed using structured questions evaluating storage/voiding symptoms. Patients were divided into two groups according to projected Isovolumetric Pressure Index (PIP1) with 30-75 cmH2O indicating normal contractility.

RESULTS

A total of 139 women were included, 29 (20.9%) in DU group and 110 (79.1%) in control group. Control and DU groups have shown similar objective (75.5% vs. 71.4% P=0.66) and subjective (85.4% vs. 96.1% P=0.22) success rates, respectively, without statistical differences. Voiding symptoms increased after surgery in both groups (+20.7% DU group vs. +8.1% normal group, P=0.29). More voiding symptoms (persistent/de novo) were found in DU group vs. normal group, but without statistically significant differences.

CONCLUSIONS

According to our results, the presence of DU previous to SUI surgery with a SIS (Altis®, Coloplast) has no impact on objective and subjective success rates. On the other hand, patients with preoperative DU showed higher proportion of voiding dysfunction but no statistical difference.

International Survey on Urodynamic Investigations in Women Undergoing Stress Urinary Incontinence Surgery

OBJECTIVE

To evaluate the role of invasive urodynamics (UD) in women candidates for stress urinary incontinence (SUI) surgery.

MATERIALS AND METHODS

This was a worldwide survey on current trends in use of preoperative invasive UD in women undergoing SUI surgery. Demographic respondents' data, whether routine invasive UD is performed before surgery and its diagnostic role were investigated.

RESULTS

The survey was completed by 504 respondents: urologists 83.1%, gynecologists 16.8%. UD findings were reported influencing the surgical decision in 84.3% of the cases and may change planned surgery in 72.4%, may discourage it in 43.6%, may change surgical expectations in 55.5%, and are useful for preoperative counselling in 96.6%. We found a very low rate of routine performance of UD for uncomplicated SUI. The most impactful UD findings were related to the conditions of detrusor contractility, overactivity and underactivity. Among voiding disorders, dyssynergia was considered the most relevant dysfunction. Valsalva Leak Point Pressure was the most reported tool to investigate urethral function. The surgical management was influenced by UD findings in the vast majority of the cases, although about 60% reported that a relevant impact of the UD occurred in less than 40% of the investigations. The crucial effect of UD on surgical management was high. This finding showed that for many respondents UD still has a pivotal role before SUI surgery.

CONCLUSION

This survey showed a worldwide picture on preoperative UD in SUI surgery highlighting the crucial role of UD. UD investigation influences surgical management, but whether it influences outcomes is unclear.