Abstract
ABSTRACTPurpose:False-negative urodynamic findings may mislead or prevent planned treatments due to unmatched findings with the clinical presentation. We hypothesized that the absence of urodynamic demonstration of SUI or OAB on urodynamics would interfere with clinical outcomes.Materials and Methods:Materials and Methods: We prospectively studied 124 women with (94) or without (30) demonstrable SUI after sling operations. Similarly, 64 women with OAB syndrome with (38) or without (26) demonstrable DO were also compared after treatment with anticholinergic agents. Patients were assessed with the UDI-6 and IIQ-7 questionnaires 3 and 6 months after treatment.Results:Only 76% of SUI patients demonstrated urine leakage during urodynamics. The UDI-6 score was higher in the demonstrable-SUI and demonstrable-DO groups, while the IIQ-7 score was comparable within the incontinence or urgency/frequency groups. Demonstrable and non-demonstrable SUI-operated patients showed similar outcomes. Patients with urgency syndromes with or without demonstrable DO had a similar rate of improvement with anticholinergic therapy.Conclusions:Women with clinical complaints of SUI objectively demonstrated on urodynamics presented the same subjective clinical outcome as those with SUI lacking objective demonstration when measured by the UDI-6 and IIQ-7 questionnaires. Similarly, patients with OAB syndrome with or without demonstrable DO had similar clinical improvement when treated with anticholinergics and measured using the same questionnaires.
Highlights
For many urologists and most certainly for many referral centers and third-party payers, urodynamic studies are a necessary and prognostic tool to evaluate bladder behavior before any therapeutic approach is implemented [1] despite good evidence that it could be waived in index cases [2, 3].Different routine laboratory tests, such as filling rates, catheter gauge, temperature of the infused fluid and patient-related physiological variations, may interfere with the detection rate of relevant information gathered during urodynamic study, confounding the reasons and first-hand expectations that prompted the assistant urologist to request the urodynamic investigation [4]
We hypothesized that the lack of demonstration of the main clinical complaint on the urodynamic study taken as a surrogate for the main diagnosis would impact the subjective clinical result measured by validated questionnaires in index SUI or OAB groups of patients
Patients were studied and split into two groups according to the presence or absence of demonstrable urinary leakage on the first session of preoperative urodynamic evaluation as it is routinely done as part of our diagnostic workup and therapeutic plan for elective sling operation
Summary
For many urologists and most certainly for many referral centers and third-party payers, urodynamic studies are a necessary and prognostic tool to evaluate bladder behavior before any therapeutic approach is implemented [1] despite good evidence that it could be waived in index cases [2, 3].Different routine laboratory tests, such as filling rates, catheter gauge, temperature of the infused fluid and patient-related physiological variations, may interfere with the detection rate of relevant information gathered during urodynamic study, confounding the reasons and first-hand expectations that prompted the assistant urologist to request the urodynamic investigation [4]. Urodynamic examination is an essential part of the medical workup to orient the intended treatment plan. We hypothesized that the lack of demonstration of the main clinical complaint on the urodynamic study taken as a surrogate for the main diagnosis would impact the subjective clinical result measured by validated questionnaires in index SUI or OAB groups of patients. Subjective outcomes measured by validated questionnaires in surgically treated SUI (stress urinary incontinence) cases with or without demonstrated urinary leakage during the exam were studied. A second scenario comprising cases with clinically urgency-frequency syndrome (OAB) with or without demonstrated DO (detrusor overactivity) during urodynamic evaluation was compared between groups after a 3-month period of anticholinergic treatment
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