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14.01.2019 | Original Article

The negative predictive value of preoperative urodynamics for stress urinary incontinence following prolapse surgery

verfasst von: Tania Sierra, Gina Sullivan, Katherine Leung, Michael Flynn

Erschienen in: International Urogynecology Journal

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Abstract

Introduction and hypothesis

There is no consensus for the evaluation of stress urinary incontinence (SUI) in patients planning pelvic organ prolapse (POP) surgery. We sought to determine the negative predictive value (NPV) of prolapse reduction during preoperative urodynamics (UDS) for postoperative SUI.

Methods

We performed a retrospective study of 322 women with preoperative UDS and subsequent POP surgery. Abstracted data included demographics, prolapse stage, prior prolapse or incontinence surgery, preoperative SUI complaint, prolapse reduction method, and length of follow-up. Any woman who reported SUI symptoms within 6 months from surgery was considered a diagnostic UDS failure. The NPV was calculated by dividing the number of patients who did not demonstrate SUI on UDS and had no postoperative SUI by the number of patients who did not demonstrate SUI on UDS.

Results

Patient characteristics (age, race, parity, prolapse stage, prior surgery, and length of follow-up) were similar among those who had urodynamic-proven SUI and those who did not. The NPV of preoperative UDS for postoperative SUI in patients undergoing any POP repair was 97.9.0% [95% confidence interval (CI) 92.7–99.7%]. The NPV remained high in the subset of patients who underwent an apical suspension—98.6% (95% CI 92.7–100.0%)—as well as those without a preoperative SUI complaint—98.6% (95% CI 92.3–100.0%). In most patients (72.9%), a ring pessary with support combined with intraprocedural manipulation allowed for reliable stress testing.

Conclusions

Our study supports using preoperative UDS as a screening tool to avoid unnecessary concomitant continence procedures. Further studies are needed to individualize patient preoperative assessment and surgical counseling.
Literatur
1.
Zurück zum Zitat Bai SW, Jeon MJ, Kim JY, et al. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(4):256. CrossRefPubMed Bai SW, Jeon MJ, Kim JY, et al. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(4):256. CrossRefPubMed
2.
Zurück zum Zitat Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66. CrossRefPubMed Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66. CrossRefPubMed
3.
Zurück zum Zitat Richardson ML, Elliott CS, Shaw JG, et al. To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol. 2013;190(4):1306–12. CrossRefPubMed Richardson ML, Elliott CS, Shaw JG, et al. To sling or not to sling at time of abdominal sacrocolpopexy: a cost-effectiveness analysis. J Urol. 2013;190(4):1306–12. CrossRefPubMed
4.
Zurück zum Zitat Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358–67. CrossRefPubMedPubMedCentral Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358–67. CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Collins CW, Winters JC. American Urological Association, Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction. AUA/SUFU adult urodynamics guideline: a clinical review. Urol Clin N Am. 2014;41(3):353–62 vii. CrossRef Collins CW, Winters JC. American Urological Association, Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction. AUA/SUFU adult urodynamics guideline: a clinical review. Urol Clin N Am. 2014;41(3):353–62 vii. CrossRef
6.
Zurück zum Zitat Duecy EE, Pulvino JQ, McNanley AR, et al. Urodynamic prediction of occult stress urinary incontinence before vaginal surgery for advanced pelvic organ prolapse: evaluation of postoperative outcomes. Female Pelvic Med Reconstr Surg. 2010;16(4):215–7. CrossRefPubMed Duecy EE, Pulvino JQ, McNanley AR, et al. Urodynamic prediction of occult stress urinary incontinence before vaginal surgery for advanced pelvic organ prolapse: evaluation of postoperative outcomes. Female Pelvic Med Reconstr Surg. 2010;16(4):215–7. CrossRefPubMed
7.
Zurück zum Zitat Elser DM, Moen MD, Stanford EJ, et al. Abdominal sacrocolpopexy and urinary incontinence: surgical planning based on urodynamics. Am J Obstet Gynecol. 2010;202(4):375.e1–5. CrossRef Elser DM, Moen MD, Stanford EJ, et al. Abdominal sacrocolpopexy and urinary incontinence: surgical planning based on urodynamics. Am J Obstet Gynecol. 2010;202(4):375.e1–5. CrossRef
8.
Zurück zum Zitat Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):607–14. CrossRefPubMedPubMedCentral Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):607–14. CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Jelovsek JE, Chagin K, Brubaker L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(2 0 1):279–87. CrossRefPubMedPubMedCentral Jelovsek JE, Chagin K, Brubaker L, et al. A model for predicting the risk of de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(2 0 1):279–87. CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Sinha D, Arunkalaivanan AS. Prevalence of occult stress incontinence in continent women with severe genital prolapse. J Obstet Gynaecol. 2007;27(2):174–6. CrossRefPubMed Sinha D, Arunkalaivanan AS. Prevalence of occult stress incontinence in continent women with severe genital prolapse. J Obstet Gynaecol. 2007;27(2):174–6. CrossRefPubMed
11.
Zurück zum Zitat Chaikin DC, Groutz A, Blaivas JG. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163(2):531–4. CrossRefPubMed Chaikin DC, Groutz A, Blaivas JG. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163(2):531–4. CrossRefPubMed
12.
Zurück zum Zitat Mueller ER, Kenton K, Mahajan S, et al. Urodynamic prolapse reduction alters urethral pressure but not filling or pressure flow parameters. J Urol. 2007;177(2):600–3. CrossRefPubMed Mueller ER, Kenton K, Mahajan S, et al. Urodynamic prolapse reduction alters urethral pressure but not filling or pressure flow parameters. J Urol. 2007;177(2):600–3. CrossRefPubMed
13.
Zurück zum Zitat Roovers JP, Oelke M. Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):455–60. CrossRefPubMed Roovers JP, Oelke M. Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):455–60. CrossRefPubMed
Metadaten
Titel
The negative predictive value of preoperative urodynamics for stress urinary incontinence following prolapse surgery
verfasst von
Tania Sierra
Gina Sullivan
Katherine Leung
Michael Flynn
Publikationsdatum
14.01.2019
Verlag
Springer International Publishing
Erschienen in
International Urogynecology Journal
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-018-03864-y

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