Preoperative Urodynamics Testing in Stress Urinary Incontinence

2021 ◽  
pp. 197-201
Author(s):  
Megan Bradley ◽  
Linda Burkett
Keyword(s):  
Urinary Incontinence ◽  
Clinical Practice ◽  
Stress Urinary Incontinence ◽  
Preoperative Evaluation ◽  
Secondary Data ◽  
Patient Characteristics ◽  
Urodynamic Testing ◽  
Incontinence Surgery ◽  
Scientific Methods ◽  
Stress Incontinence Surgery

This article outlines the scientific methods, results, and conclusions for the ValUE trial, “A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery.” The ValUE trial compared patients with stress urinary incontinence (SUI) who underwent office evaluation with or without preoperative urodynamics (UDS) testing prior to an anti-incontinence procedure. The majority of patients in the study underwent a mid-urethral sling. The study showed no difference in surgical or treatment outcomes for patients with uncomplicated SUI, signifying UDS may not be necessary in preoperative evaluation. Patient characteristics of uncomplicated SUI are discussed for translation into clinical practice. Reviews of related articles with secondary data analysis are summarized.

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

2008 ◽  
Vol 8 ◽  
pp. 1259-1268 ◽  
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.

A Randomized Trial of Urodynamic Testing Before Stress Incontinence Surgery

2021 ◽  
pp. 233-238
Author(s):  
Colby A. Dixon ◽  
Giulia I. Lane ◽  
Cynthia S. Fok ◽  
M. Louis Moy
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Randomized Trial ◽  
Success Rate ◽  
Stress Incontinence ◽  
Surgical Planning ◽  
Urodynamic Testing ◽  
Incontinence Surgery ◽  
Additional Testing ◽  
Stress Incontinence Surgery

This chapter summarizes the results of the VALUE trial, in which women with stress urinary incontinence scheduled to undergo incontinence surgery were randomized to undergo preoperative urodynamic testing versus office evaluation alone. Treatment was considered successful in a similar, large proportion of women in both groups. A diagnosis of stress urinary incontinence was confirmed in most of the women who underwent urodynamic testing; changes were made to their surgical planning on the basis of the additional testing in very few of them. These findings suggested that urodynamic testing may not contribute to the overall success rate of surgery in healthy women with uncomplicated stress urinary incontinence.

Surgical Management of Stress Urinary Incontinence

2018 ◽  
Author(s):  
Danielle Patterson
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Midurethral Sling ◽  
Preoperative Evaluation ◽  
Urine Volume ◽  
Urodynamic Testing ◽  
Fascial Sling ◽  
Urethral Bulking ◽  
Postvoid Residual Urine ◽  
Distressing Condition

Stress urinary incontinence (SUI) is a prevalent and distressing condition that affects up to 50% of women over their lifetime. If nonsurgical treatments are not effective, surgery is highly successful. Preoperative evaluation includes at minimum a thorough history and physical examination, urinalysis, demonstration of SUI, assessment of urethral mobility, and measurement of postvoid residual urine volume. The midurethral sling is the most studied surgical procedure for urinary incontinence and is safe and highly effective. With the recent concern about permanent mesh in urogynecologic surgery, many patients might choose a laparoscopy- or robot-assisted Burch colposuspension or fascial sling. This review contains 5 figures, 5 tables and 38 references Key words: intrinsic sphincter deficiency, mesh, midurethral sling, minimally invasive surgery, preoperative evaluation, retropubic colposuspension, stress urinary incontinence, urethral bulking, urodynamic testing

scholarly journals Contemporary trends for urological training and management of stress urinary incontinence in Ireland

2021 ◽  
Author(s):  
Eoin MacCraith ◽  
James C. Forde ◽  
Fergal J. O’Brien ◽  
Niall F. Davis
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Fold Increase ◽  
Incontinence Surgery ◽  
Stress Urinary Incontinence Surgery ◽  
Urethral Bulking ◽  
Urological Training ◽  
Sui Surgery ◽  
Urinary Incontinence Surgery ◽  
Urethral Bulking Agent

Abstract Introduction and hypothesis The aim of this study is to evaluate the trends in stress urinary incontinence (SUI) surgery since the 2018 pause on use of the polypropylene (PP) mid-urethral sling (MUS) and to quantify the effect this has had on surgical training. Methods Two anonymous surveys were sent to all current urology trainees and to all consultant surgeons who specialise in stress urinary incontinence surgery. Results Prior to the pause, 86% (6 out of 7) of consultant urologists and 73% (11 out of 15) of consultant gynaecologists would “always”/“often” perform MUS for SUI. After that, 100% (22 out of 22) of consultants reported that they “never” perform MUS. There has been a modest increase in the use of urethral bulking agent (UBA) procedures among urologists, with 43% (3 out of 7) now “often” performing this, compared with 71% (5 out of 7) “never” performing it pre-2018. Trainee exposure to SUI surgery reduced by 75% between 2016 and 2020. Despite a ten-fold increase in UBA procedures logged by trainees, the decline in MUS has resulted in a major reduction in total SUI surgeries. Coinciding with this decrease in surgeries, there was a 56% reduction in trainees’ self-assessed competence at SUI surgery. Thirteen percent of trainees are interested in specialising in Female Urology and those trainees had significantly greater exposure to SUI procedures during their training than those who did not (p = 0.0072). Conclusions This study has identified a downward trend in SUI surgery, which is concerning for the undertreatment of females with SUI. A decline in SUI surgery training has resulted in reduced trainee confidence and interest in this subspecialty.

Stress Urinary Incontinence Surgery in the United States

2003 ◽  
Vol 101 (4) ◽  
pp. 671-676
Author(s):  
L. Elaine Waetjen ◽  
Leslee L. Subak ◽  
Hui Shen ◽  
Feng Lin ◽  
Tsung-Hsi Wang ◽  
...  
Keyword(s):  
United States ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
The United States ◽  
Incontinence Surgery ◽  
Stress Urinary Incontinence Surgery ◽  
Urinary Incontinence Surgery

scholarly journals Minimally Invasive Therapies for Female Stress Urinary Incontinence: the Current Status of Bioinjectables/New Devices (Adjustable Continence Therapy, Urethral Submucosal Collagen Denaturation by Radiofrequency)

2009 ◽  
Vol 9 ◽  
pp. 466-478 ◽  
Author(s):  
Simone Crivellaro ◽  
John J. Smith
Keyword(s):  
Clinical Trials ◽  
Urinary Incontinence ◽  
Clinical Practice ◽  
Stress Urinary Incontinence ◽  
Minimally Invasive ◽  
Emerging Technologies ◽  
Current Status ◽  
Female Stress Urinary Incontinence ◽  
Salvage Procedure ◽  
Collagen Denaturation

The aim of this review is to provide an update on the current status of evolving minimally invasive therapies for stress urinary incontinence. Bioinjectables have been available for some time and their current status is reviewed. The adjustable continence device has been used as a salvage procedure for females for a number of years in clinical trials, yet many are unfamiliar with it. Lastly, radiofrequency via a transurethral route has also been utilized in small numbers and will be updated. These later two emerging technologies need further exposure to better define their role in our clinical practice.

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