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Role of Urodynamic Testing in the Assessment of Female SUI

  • - Female Urology & Urogynecology - Urodynamic Evaluation of Female Stress Urinary Incontinence
  • Jul 09, 2010
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Tags: | bladder overactivity | bladder pressure | cause of incontinence | dlpp |

Although urodynamic testing is frequently performed as part of the evaluation of SUI, the benefits obtained by performing such testing have not been well defined. Advocates of a “minimalist” approach argue that direct observation of stress incontinence on physical examination is sufficient to allow the treating physician to proceed with surgery in the majority of patients. Some studies have indicated that routine performance of urodynamics in the evaluation of female stress incontinence is not cost-effective (12,13).

This opinion has perhaps become more prevalent with the advent of minimally invasive midurethral sling procedures, which have yielded good continence results in large, heterogeneous patient samples. Advocates for urodynamic testing argue that important information about concomitant bladder dysfunction (detrusor overactivity, compliance abnormalities, poor detrusor contractile function) may significantly alter the treatment approach in certain patients.

Furthermore, identification of urodynamic intrinsic sphincter deficiency does appear to significantly reduce the stress incontinence cure rate for midurethral slings (14,15).

Currently, it is not known if routine urodynamic assessment improves outcomes prior to stress incontinence surgery. Therefore, the decision to perform this testing is individualized based on the availability of the testing equipment, the expertise of the treating physician, and the complexity of the patient.

Urodynamic Evaluation of Female Stress Urinary Incontinence

Urodynamic Evaluation of Female Stress Urinary Incontinence

The utility of preoperative urodynamic testing will continue to be controversial until definitive studies are carried out to examine the issue. Ideally, these would be multicenter, prospective, randomized trials involving women who have undergone standardized urodynamic testing, with the treating physician blinded to the urodynamic outcomes in one group and aware of the outcomes in the other.

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Kelly M. Maxwell, MD, and J. Quentin Clemens, MD, MSCI
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REFERENCES

  1. Leach GE, Dmochowski RR, Appell RA, et al. Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. J Urol 1997;158: 875-880.
  2. McGuire EJ, Fitzpatrick CC, Wan J, et al. Clinical assessment of urethral sphincter function. J Urol 1993;150(5 pt 1):1452-1454.
  3. Stiltberg H, Larsson G, Victor A. Reproducibility of a new method to determine cough-induced leak-point pressure in women with stress urinary incontinence. Int Urogynecol J 1996;7:13-19.
  4. Bump RC, Elser DM, McClish DK. Valsalva leak point pressures in adult women with genuine stress urinary incontinence: reproducibility, effect of catheter caliber, and correlations with passive urethral pressure profilometry. Neurourol Urodyn 1993;12:307-308.
  5. Rud T, Andersson KE, Asmussen M, Hunting A, Ulmsten U. Factors maintaining the intraurethral pressure in women. Invest Urol 1980;17:343-347.
  6. Bonney V. On diurnal incontinence of urine in women. J Obstet Gynaecol Br Emp 1923;30:358-365.
  7. Lose G, Griffiths D, Hosker G, et al. Standardisation of urethral pressure measurement: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn 2002;21:258-260.
  8. Weber AM. Is urethral pressure profilometry a useful diagnostic test for stress urinary incontinence? Obstet Gynecol Surv 2001;56:720-735.
  9. Bump RC, Copeland WE, Jr, Hurt WG, Fantl JA. Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress-incontinent and stress continent subjects. Am J Obstet Gynecol 1988;159:749-755.
  10. Slack M, Culligan P, Tracey M, Hunsicker K, Patel B, Sumeray M. Relationship of urethral retroresistance pressure to urodynamic measurements and incontinence severity. Neurourol Urodyn 2004; 23:109-114.
  11. Slack M, Tracey M, Hunsicker K, Godwin A, Patel B, Sumeray M. Urethral retro-resistance pressure: a new clinical measure of urethral function. Neurourol Urodyn 2004;23:656-661.
  12. Diokno AC, Dimaculangan RR, Lim EU, Steinert BW. Office based criteria for predicting type II stress incontinence without further evaluation studies. J Urol 1991;161:1263-1267.
  13. Weber AM, Taylor RJ, Wei JT, Lemack G, Piedmonte MR, Walters MD. The cost-effectiveness of preoperative testing (basic office assessment vs urodynamics) for stress urinary incontinence in women. BJU Int 2002;89:356-363.
  14. Liapis A, Bakas P, Salamalekis E, Botsis D, Creatsas G. Tension-free vaginal tape (TVT) in women with low urethral closure pressure. Eur J Obstet Gynecol Reprod Biol 2004;116:67-70.
  15. Paick JS, Ku JH, Shin JW, Son H, Oh S, Kim SW. Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure. J Urol 2004;172:1370-1373.

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