Elsevier

The Journal of Urology

Volume 179, Issue 4, April 2008, Pages 1470-1474
The Journal of Urology

Adult Urology
Voiding dysfunction
Urodynamic Measures Do Not Predict Stress Continence Outcomes After Surgery for Stress Urinary Incontinence in Selected Women

https://doi.org/10.1016/j.juro.2007.11.077Get rights and content

Purpose

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.

Section snippets

Materials and Methods

A total of 655 women with stress predominant urinary incontinence symptoms were randomized between February 2002 and June 2004 at 9 clinical sites. Details of the enrollment criteria have been previously published.7 Notably all women were deemed eligible for study by their surgeon for either continence procedure, and demonstrated dominant stress symptoms on a MESA questionnaire,9 a voiding frequency of 12 times or less per day, a positive cough stress test, a bladder capacity of 200 ml,

Results

A total of 655 women were randomized (326 sling, 329 Burch), 520 (79%) completed the 24 months overall outcome assessment and 543 (83%) completed the 24-month stress specific outcome assessment. Of the women with measured outcomes approximately 98% had the urodynamic measures of USI or DO recorded. Of the 520 women with overall outcome data 511 had USI status available and 514 had DO status available. Of the 543 with stress specific outcomes 534 had USI status available and 536 had DO status

Discussion

Our study findings suggest that demonstrable USI during the filling phase of urodynamic testing is not prognostic of continence after SUI surgery in carefully selected women with predominantly stress urinary incontinence. We did identify a trend favoring overall success for women with USI compared to those without USI that did not quite reach statistical significance (OR 2.26; 95% CI 0.99, 5.17). To our surprise the failures were not due to detrusor overactivity or self-reported urge symptoms.

Conclusions

We found a nearly statistically significant trend that women with USI are twice as likely to have a successful overall outcome from surgical management of SUI as women without USI. The level of VLPP and the presence of DO do not predict the success of outcomes after the Burch or autologous fascia sling procedures in women with pure or predominant SUI. The impact of UDS on surgical outcomes needs further investigation.

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Study received institutional review board approval.

Financial interest and/or other relationship with NIDDK, Pfizer, Novartis, Lilly and Laborie.

Financial interest and/or other relationship with Pfizer and Procter & Gamble.

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Financial interest and/or other relationship with Pfizer, Novartis, Allergan and Astellas.

Financial interest and/or other relationship with Eli Lilly.

Financial interest and/or other relationship with Astellas, Dynogen, Pfizer, Allergan and Sanofi-Aventis.

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