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Ruffolo AF, Tsiapakidou S, Daykan Y, Salvatore S, Athanasiou S, Braga A, Meschia M, Phillips C, Serati M. European Urogynaecological Association Position Statement: The role of urodynamics in stress urinary incontinence evaluation and treatment decision. Eur J Obstet Gynecol Reprod Biol 2024; 297:176-181. [PMID: 38669769 DOI: 10.1016/j.ejogrb.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Stress urinary incontinence (SUI) is defined as a condition characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure which may decrease quality of life with a significant economic impact on health systems, necessitating the implementation of cost-effective management plans. Urodynamics (UDS) has been considered during the last decades as the gold standard for assessment of lower urinary tract symptoms (LUTS) due to their high reproducibility. At the same time, concerns about the systematic use of UDS before SUI surgery were raised due to a limited evidenced base to recommend their routine use. In uncomplicated female patients with SUI, UDS can offer further insights into LUTS, potentially assisting the physician in determining the appropriate therapeutic approach. However, it has not been shown that preoperative UDS can directly impact the surgical outcome for continence. Indeed, evidence supports the conclusion that pre-operative UDS in women with uncomplicated, clinically demonstrable, SUI does not improve the outcome of surgery for SUI. Nevertheless, asymptomatic detrusor overactivity (DO) identified by urodynamic testing or pre-existing voiding dysfunction are associated with an increased occurrence of postoperative overactive bladder (OAB) and voiding dysfunction, respectively. The EUGA Working Group concluded that the evidence does not support the systematic preoperative use of UDS for uncomplicated cases. However, in cases where mixed symptoms, voiding dysfunction, previous surgery, or concomitant prolapse are present, preoperative UDS are advised as they can be beneficial in anticipating postoperative outcomes. This aids in conducting comprehensive and thorough preoperative counseling. The Group recommend performing preoperative UDS considering the patient's specific clinical situation and the surgeon's judgment, with consideration given to the potential benefits, risks, and impact on treatment decisions and patient outcomes.
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Affiliation(s)
| | - Sofia Tsiapakidou
- 1(st) Department of Obstetrics and Gynecology Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, Scientific Institute, Milan, Italy
| | - Stavros Athanasiou
- Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | - Michele Meschia
- Co-Chair of Scientific Committee of European Urogynaecological Association (EUGA)
| | - Christian Phillips
- Basingstoke and North Hampshire Hospital, Urogynaecology, Basingstoke, Hampshire, United Kingdom
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; President of European Urogynaecological Association (EUGA)
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Braga A, Finazzi Agrò E, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Serati M. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 1 - Female population. MINERVA UROL NEFROL 2020; 72:58-65. [PMID: 31086135 DOI: 10.23736/s0393-2249.19.03443-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Although, until a few years ago, the diagnostic power of urodynamic testing had never been questioned, recent studies in the literature have raised some doubts on the routine use of this tool. The benefits of the urodynamic studies (UDS) should be weighted against costs, time-consumption and patient discomfort. These recommendations are intended to guide clinicians in the right selection of the female patients to submit to a urodynamic evaluation. We reviewed the literature, regarding the use of UDS in female adults with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction. Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and uro-gynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in female population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with lower urinary tract symptoms and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, Beata Vergine Regional Hospital, Mendrisio, Switzerland -
| | | | - Ester Illiano
- Department of Urology and Andrology Clinic, Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Serati M, Braga A, Torella M, Soligo M, Finazzi-Agro E. The role of urodynamics in the management of female stress urinary incontinence. Neurourol Urodyn 2019; 38 Suppl 4:S42-S50. [PMID: 31045271 DOI: 10.1002/nau.23865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/30/2018] [Indexed: 11/11/2022]
Abstract
AIM The role of urodynamic study (UDS) in the management of female stress urinary incontinence (SUI) is one of the most controversial and debated topic in urogynecology. Here, we aimed to systematically assess the most relevant available evidence on urodynamics' value in the management of women with stress urinary incontinence. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed in May 2018. Only randomized clinical trials, prospective studies, or retrospective studies articles evaluating the use of urodynamic studies in women with stress urinary incontinence were included. RESULTS After screening a total of 3055 records, 39 studies published from 1996 to 2018 were included. CONCLUSIONS In an uncomplicated population of women with SUI, it is not demonstrated that preoperative urodynamic evaluation can improve the outcome of continence surgery; however, UDS provides additional information regarding lower urinary tract function that could guide the physician to make the right therapeutic choice. UDS should be considered mandatory before surgery in complicated patients, but its use should also be evaluated in index patients when the results may help counseling and management of these women.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Depaerment of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Swiss
| | - Marco Torella
- Department of Obstetrics and Gynecology, Child and General and Specialized Surgery-Second University of Naples, Naples, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Unit for Functional Urology, Tor Vergata University Hospital, Rome, Italy
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Urodynamics Before Surgery for Stress Urinary Incontinence: The Urodynamic Examination Is Still One of the Best Friends of the Surgeon and of Patients with Stress Urinary Incontinence. Eur Urol Focus 2016; 2:272-273. [DOI: 10.1016/j.euf.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Khayyami Y, Klarskov N, Lose G. Post-void residual urine under 150 ml does not exclude voiding dysfunction in women. Int Urogynecol J 2015; 27:467-73. [PMID: 26423261 DOI: 10.1007/s00192-015-2854-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS It has been claimed that post-void residual urine (PVR) below 150 ml rules out voiding dysfunction in women with stress urinary incontinence (SUI) and provides license to perform sling surgery. The cut-off of 150 ml seems arbitrary, not evidence-based, and so we sought to investigate the ability of PVR < 150 ml to exclude voiding dysfunction. METHODS We retrospectively reviewed the charts of all patients who underwent invasive urodynamics from 1 January 2013 to 31 December 2013. Voiding dysfunction was diagnosed if both the invasive urodynamic and the free flow showed abnormal results. We registered the PVR in patients with voiding dysfunction and divided them into groups with PVR < 150 ml and PVR ≥ 150 ml. Patients were then analyzed for bladder outlet obstruction and detrusor underactivity. RESULTS Of the 205 patients undergoing invasive urodynamics in 2013, a total of 20 had voiding dysfunction, 2 with PVR ≥ 150 ml. Eighteen patients had PVR < 150 ml (range 0-50 ml); 9 had bladder outlet obstruction while 7 had detrusor underactivity. Two patients were uncategorized. Out of the 20 patients, 7 had no symptoms or complaints indicating voiding dysfunction. CONCLUSIONS Patients with voiding dysfunction often have normal PVR and so PVR < 150 ml cannot exclude voiding dysfunction. All patients should be evaluated using free flow measurements along with PVR to obtain a reliable, objective measurement of their voiding pattern, before anti-incontinence surgery.
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Affiliation(s)
- Yasmine Khayyami
- Department of Gynecology and Obstetrics, University of Copenhagen, Herlev hospital, Herlev, Denmark.
- , Pileskellet 12, 2000, Frederiksberg, Denmark.
| | - Niels Klarskov
- Department of Gynecology and Obstetrics, University of Copenhagen, Herlev hospital, Herlev, Denmark
| | - Gunnar Lose
- Department of Gynecology and Obstetrics, University of Copenhagen, Herlev hospital, Herlev, Denmark
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Agarwal A, Rathi S, Patnaik P, Shaw D, Jain M, Trivedi S, Dwivedi US. Does preoperative urodynamic testing improve surgical outcomes in patients undergoing the transobturator tape procedure for stress urinary incontinence? A prospective randomized trial. Korean J Urol 2014; 55:821-7. [PMID: 25512817 PMCID: PMC4265717 DOI: 10.4111/kju.2014.55.12.821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/15/2014] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Abhinav Agarwal
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sudheer Rathi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Pranab Patnaik
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Dipak Shaw
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Madhu Jain
- Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sameer Trivedi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Udai Shankar Dwivedi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Role of urodynamics before prolapse surgery. Int Urogynecol J 2014; 26:165-8. [PMID: 25315173 DOI: 10.1007/s00192-014-2534-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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Cetinel B, Demirkesen O, Onal B, Erdal S, Gezer M. Is It Possible to Predict Urodynamic Stress Urinary Incontinence in Women with Minimal Diagnostic Evaluation? Urol Int 2014; 93:444-8. [DOI: 10.1159/000362823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022]
Abstract
<b><i>Objectives:</i></b> To determine whether it is possible to predict urodynamic stress urinary incontinence (uSUI) in women with minimal diagnostic evaluation. <b><i>Materials and Methods:</i></b> Medical records of 2,643 female incontinent patients were reviewed and 301 women were eligible for this study. The positive predictive values (PPV), sensitivity, specificity and negative predictive values (NPV) for uSUI and uSUI with or without detrusor overactivity (DO), and DO patients of pure SUI symptom (group 1), combination of pure SUI symptom and positive provocative stress test (+PST; group 2) and combination of pure SUI symptom, +PST and absence of overactive bladder symptoms (group 3) were calculated for each group. <b><i>Results:</i></b> Mean age was 51.03 years (22-88). PPV, sensitivity and specificity values for uSUI with or without DO of group 3 were 100, 7.4, and 100%, while these values for pure uSUI were 93.3, 9.3, and 99.3%, respectively. Interestingly, none of the patients in groups 2 and 3 had DO. <b><i>Conclusions:</i></b> Our results show that it was possible to predict uSUI with high accuracy using minimal diagnostic evaluation in a group of female patients with pure stress incontinence symptoms +PST while it was also possible to eliminate DO accurately in this group of patients.
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Outpatient surgical treatment of female stress urinary incontinence under local anesthesia-sedation with contrasure needleless incision. Actas Urol Esp 2014; 38:49-54. [PMID: 23639237 DOI: 10.1016/j.acuro.2013.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 12/09/2012] [Accepted: 01/07/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International). PATIENTS AND METHOD We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 to December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention. RESULTS Tolerance to the procedure was good. Surgical time was less than 10 minutes and stay in the hospital up to discharge less than 2hours. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%. CONCLUSIONS Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation "minibands" due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required.
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Del Popolo G, Li Marzi V, Serati M. Do preoperative urodynamics still have a role in female stress urinary incontinence? Neurourol Urodyn 2013; 32:1144-5. [PMID: 23861312 DOI: 10.1002/nau.22338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 09/24/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Maurizio Serati
- Department of Obstetrics and Gynecology; University of Insubria, Del Ponte Hospital; Varese Italy
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Serati M, Cattoni E, Siesto G, Braga A, Sorice P, Cantaluppi S, Cromi A, Ghezzi F, Vitobello D, Bolis P, Salvatore S. Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence? BJU Int 2013; 112:E344-50. [PMID: 23421421 DOI: 10.1111/bju.12007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To identify how many patients with symptoms of pure stress urinary incontinence (SUI) do not require any surgical treatment on the basis of urodynamics (UDS) and how many patients still do not require surgery 1 year after UDS. To assess the outcomes of these patients at 12-month follow-up. PATIENTS AND METHODS Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS. Women with USI underwent a Tension Free Vaginal Tape (Obturator) (TVT-O) procedure (Gynecare; Ethicon Inc., Somerville, NJ, USA), whereas women with DO ±/- USI were recommended 24-week antimuscarinic therapy. Follow-up was scheduled at 3 and 12 months. To define subjective outcomes, all patients completed the International Consultation on Incontinence Questionnaire - short form, the Patient Global Impression - Improvement and the Urinary Distress Inventory. Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the Urinary Distress Inventory and a response of 'much better' or 'very much better' on the Patient Global Impression - Improvement. RESULTS Of the 263 women with pure SUI, 74.5% had a urodynamic diagnosis of USI, 10.6% had DO, 8% had USI + DO and 6.8% had inconclusive UDS. At 12-month follow-up, 165/181 (91.6%) women in group 1 were considered cured post-TVT-O; in the other groups, 33/67 (49.2%) patients were considered cured simply as a result of taking antimuscarinics; 13 of these 67 patients required TVT-O. CONCLUSIONS UDS is able to show that several patients with symptoms of pure SUI present an underlying DO and do not require surgery, even 1 year after UDS. In these patients, antimuscarinic treatment appears to ensure a good rate of cure; thus, UDS could lead to the avoidance of several surgical procedures.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Mohammed A, Maguire T, Biers S, Terry TR. Persistent and recurrent stress urinary incontinence following mid-urethral tape surgery in women: a UK perspective. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/1875974212465578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stress urinary incontinence is a common health problem that affects a large proportion of women in Britain. It poses physical and psychological implications for the affected women and is a frequent indication for referral to tertiary urology centres. Midurethral tape surgery (MUTS) has established itself as the standard first-line surgical treatment as a result of its low morbidity, short hospital stay and high long-term success. Failure of the initial surgery can present as persistent or recurrent symptoms. This is a major challenge to the treating urologists as a result of the complicated nature of the condition and the lack of strong evidence supporting individual treatment modalities. In this article we discuss the factors associated with MUTS failure and the surgical options for its treatment.
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Affiliation(s)
- Aza Mohammed
- Kettering General Hospital, Northamptonshire, UK
| | | | | | - Tim R Terry
- Kettering General Hospital, Northamptonshire, UK
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Words of wisdom. Re: A randomized trial of urodynamic testing before stress-incontinence surgery. Eur Urol 2012; 62:730-1. [PMID: 22939421 DOI: 10.1016/j.eururo.2012.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Reproducibility of a cough and jump stress test for the evaluation of urinary incontinence. Int Urogynecol J 2012; 23:1449-53. [DOI: 10.1007/s00192-012-1733-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW The diagnosis of intrinsic sphincter deficiency became important about 20 years ago when it influenced the choice of operative procedure for women with stress urinary incontinence. However, it was ill-defined and diagnosed by a variety of techniques. The contemporary surgical treatment of urinary stress incontinence is by suburethral sling; so this review addresses three questions: is it still important to identify intrinsic sphincter deficiency prior to surgical intervention for stress incontinence? What techniques are available to do so? How robust are these measurements? RECENT FINDINGS There is some evidence that women with intrinsic sphincter deficiency have a poorer outcome if they are treated by a transobturator tape compared with a tension-free vaginal tape or a pubovaginal sling. Intrinsic sphincter deficiency continues to be mainly identified by low urethral closure pressures or low abdominal leak point pressures or both but the methodology is variable. There have been some attempts at using ultrasound to identify intrinsic sphincter deficiency but without any definite conclusions. SUMMARY Intrinsic sphincter deficiency is an imprecise diagnosis, which continues to be defined by a low pressure urethra. This can be measured in different ways but there is poor standardization of the tests to do so. Intrinsic sphincter deficiency appears to be clinically important but the full implications of this diagnosis will remain unknown until this imprecision is addressed.
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[Stress incontinence and urogenital prolapse in women. What is decisive for successful surgical management?]. Urologe A 2009; 48:473-9. [PMID: 19421797 DOI: 10.1007/s00120-009-1974-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Surgery is indicated after failure of conservative treatment modalities in women with urinary stress incontinence and/or urogenital prolapse. As postoperative success rates and patients' satisfaction rates are highly dependent on patient selection and correct indication, the preoperative diagnostic work-up is essential to identify risk factors to predict postoperative continence rates, possible side effects, or complications. In these cases, patients have to be not only informed about failures prior to surgery but also offered alternative treatment options.
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