The role of urodynamic testing in the evaluation of subtle neurologic lesions

Women with significant genitourinary prolapse may be continent in spite of a weak urethral sphincter because of kinking of the poorly supported urethra. After the surgery for prolapse 19-30 % of the patients identify “occult” urinary incontinence due to a weak urethral sphincter. The aim of this study is to evaluate the role of complex urodynamic testing to identify “occult” urinary incontinence, neuromuscular dysfunction of the bladder and urethra for adequate combined therapy. Methods: 257 female patients with no urinary incontinence at the age of 30-86 years old were examined, before the surgery the pelvic organ prolapse of II-IV stages was reduced by Simps vaginal speculum: 102 women were clinically tested, and 155 women were complexly (clinically and urodynamically) evaluated. In addition to clinical examination urodynamic testing was made. Complex examination was repeated to all of them after 1-3 and 12-36 months after the operation. Results: Decrease of values of abdominal pressure transmission (APT) of less than 100 % was found significantly more often (38 ± 3.9 %) compared to a positive cough test while clinical exami-nation(19.4 ± 3.2 %) P < 0.001. Preoperatively detrusor overactivity was diagnosed in 12.5 ± 3.5 % and 11.8 ± 4.2 % cases, urethral instability - in 3.1 ± 1.7 % and 5.1 ± 2.8 % cases, detrusor sphincter dyssynergy - in 3.1 ± 1.7 % and 1.7 ± 1.6 % cases, detrusor hypotonia in 9.4 ± 3.0 % and 13.5 ± 4.4 % cases of patients with APT of more than 100 % and less than 100 % respectively. Patients with detrusor overactivity, urethral instability, detrusor hypotonya got medical preoperation treatment during 3 months and longer. 6 patients with detrusor-sphincter dyssynergy, detrusor hypotension were contraindicated for sling operation. Patients who had clinically and urodynamically confirmed urinary incontinence underwent simultaneous sling operations (13 women in a clinical group and 51 - in a complex group). In 12-36 months after the surgery no patient with APT of more than 100 % showed urinary incontinence. Clinically examined patients revealed totally 7 out of 102 (7.14 ± 2.5 %) complications after 12-36 months after surgery (mixed urinary incontinence in 4 cases and difunctional urination due to hypotonia detuzor in 3 cases). There are no these complications in the group of complexly examined women. Conclusions: Urodynamic testing can identify those women at risk of developing postoperative urinary incontinence and difunctional urination so that prophylactic measures can be undertaken. In cases when neuromuscular dysfunction is corrected and values of APT are less than 100 % simultaneous sling operation is reasonable.

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Optimization of diagnostics and treatment of mixed and stress urinary incontinence in women

Journal of obstetrics and women s diseases ◽

10.17816/jowd63344-52 ◽

2014 ◽

Vol 63 (3) ◽

pp. 44-52

Author(s):

Yelena Ivanovna Rusina

Keyword(s):

Urinary Incontinence ◽

De Novo ◽

Pelvic Organ ◽

Surgical Correction ◽

Urodynamic Testing ◽

Mixed Incontinence ◽

Muscular Dysfunction ◽

Sling Surgery

Save or occurrence «de novo» of the bladder and urethra dysfunction in surgical correction of urinary incontinence (UI) among women is impotant problem of Urogynecology. Purpose: To evaluate the role of complex diagnostics in determination of the pathogenetically based tactics with mixed and stress incontinence among women. Materials and Methods: The study included 633 patients 22-88 years old with complaints of mixed (n = 356) and stress (n = 277) UI before treatment (medical, physiotherapy, sling surgery): 119 - clinically, 514 - complexly (clinical examination and complex urodynamic testing). Surgical correction of pelvic organ prolapse is performed to 270 patients. Complex examination was repeated to all of them in 1-3 and 12-36 months after treatment. Results: detrusor overactivity - DO (32.9 %) and urethral instability (23.1 %) before surgery is more common among patients with complaints of mixed incontinence, but among patients with stress complaints this pathology is also found in 5 %, and 8.3 % of cases, respectively. 55.9 % patients with complaints of mixed incontinence and 47.2 % - with stressful complaints were not operated in connection with full or significant reduction of complaints on the background of pathogenic conservative therapy. The efficacy of sling operations for stress and mixed incontinence is high but not statistically different and generally amounts to 97.1 % in 3-36 months after surgery. The frequency of postoperative dysfunction among clinically examined patients with complaints of mixed incontinence was in general 46 %, the frequency among complexely examined patients - 9.7 %. (OR 7,7, 95 % CI 2,9-20,3). Conclusion: Complex examination with the use of urodynamic testing, the therapy of bladder and urethra neuro-muscular dysfunction, the selection of patients for surgical treatment leads to a significant reduction of dysfunction number in early and late postoperative period and improve patients’ satisfaction with the treatment.

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Diagnostic Categories of Incontinence and the Role of Urodynamic Testing

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1990.tb03509.x ◽

1990 ◽

Vol 38 (3) ◽

pp. 300-305 ◽

Cited By ~ 27

Author(s):

Ananias C. Diokno

Keyword(s):

Urodynamic Testing ◽

Diagnostic Categories

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Urodynamics: Examining the Current Role of UDS Testing. What is the Role of Urodynamic Testing in Light of Recent AUA Urodynamics and Overactive Bladder Guidelines and the VALUE Study?

Current Urology Reports ◽

10.1007/s11934-013-0361-6 ◽

2013 ◽

Vol 14 (5) ◽

pp. 403-408 ◽

Cited By ~ 13

Author(s):

Elizabeth Timbrook Brown ◽

Ryan M. Krlin ◽

J. Christian Winters

Keyword(s):

Overactive Bladder ◽

Urodynamic Testing ◽

Current Role

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Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

The Scientific World JOURNAL ◽

10.1100/tsw.2008.159 ◽

2008 ◽

Vol 8 ◽

pp. 1259-1268 ◽

Cited By ~ 11

Author(s):

Sophie G. Fletcher ◽

Gary E. Lemack

Keyword(s):

Risk Factors ◽

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Voiding Dysfunction ◽

Preoperative Evaluation ◽

Urodynamic Testing ◽

Preoperative Risk Factors ◽

Stress Incontinence Surgery ◽

Surgical Failure

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence (SUI) with urodynamic testing (UDS) enhances surgical outcomes. Nonetheless, UDS is frequently utilized in the assessment of women with SUI in the hopes that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. Poorer outcomes for stress incontinence surgery are primarily attributed to intrinsic sphincter deficiency (ISD), detrusor overactivity (DO), and voiding dysfunction. The ability of UDS to identify and characterize those parameters reliably remains under investigation. Furthermore, debate continues regarding the association of each of those factors with postoperative success for various SUI procedures. Since UDS is invasive, costly, and not always available, it is imperative that its benefit be carefully explored. In this review, we discuss the value of UDS in identifying risk factors for poor outcome and how those risk factors are associated with surgical failure.

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