Adult UrologyVoiding dysfunctionUrodynamic Measures Do Not Predict Stress Continence Outcomes After Surgery for Stress Urinary Incontinence in Selected Women
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.
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Financial interest and/or other relationship with NIDDK, Pfizer, Novartis, Lilly and Laborie.
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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.
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Financial interest and/or other relationship with Eli Lilly.
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Financial interest and/or other relationship with Astellas, Dynogen, Pfizer, Allergan and Sanofi-Aventis.