Impact of preoperative urodynamics on women undergoing pelvic organ prolapse surgery.

Autor: Glass D; Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA., Lin FC; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA, USA. fclin@mednet.ucla.edu., Khan AA; Department of Urology, Mayo Clinic, Scottsdale, AZ, USA., Van Kuiken M; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA, USA., Drain A; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, New York University, New York, NY, USA., Siev M; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, New York University, New York, NY, USA., Peyronett B; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, New York University, New York, NY, USA., Rosenblum N; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, New York University, New York, NY, USA., Brucker BM; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, New York University, New York, NY, USA., Nitti VW; Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2020 Aug; Vol. 31 (8), pp. 1663-1668. Date of Electronic Publication: 2019 Aug 27.
DOI: 10.1007/s00192-019-04084-8
Abstrakt: Introduction and Hypothesis: Preoperative urodynamic studies (UDS) are frequently performed before pelvic organ prolapse (POP) surgery to assess urethral and bladder function. The primary goal of this study is to examine how preoperative UDS are utilized and what value these studies have in patient treatment and/or counseling.
Methods: We retrospectively reviewed patients who underwent prolapse surgery and had preoperative UDS between June 2010 and February 2015. Indications for UDS were classified into four categories: (1) occult stress urinary incontinence only, (2) overactive bladder symptoms, (3) mixed or insensible urinary incontinence, and (4) voiding symptoms and/or elevated post-void residual. We identified changes in management or counseling that were directly attributable to UDS results prior to surgery.
Results: Three hundred ninety-two patients underwent urodynamic testing for indications 2-4 above, and 316 met the inclusion criteria. Fifty-seven percent (180/316) had OAB symptoms (34.4% wet, 65.6% dry), 40.2% (127/316) had mixed incontinence, and 17.1% (54/316) had voiding symptoms and/or elevated PVR. A total of 3.5% (11/316) patients had alteration in their management or counseling based on the results of the UDS; 29.4% (50/170) of the women evaluated for occult SUI alone or with other symptoms demonstrated it and 41 underwent sling placement.
Conclusions: UDS did not have a significant impact on preoperative management or counseling in POP surgery if demonstration of occult SUI was not the indication for preoperative study in women committed to POP surgery. Major alterations in treatment were rare and occurred mostly in women with stress incontinence that also had concomitant voiding symptoms and/or elevated PVR.
Databáze: MEDLINE
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