MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE Susane Hwang, Luis Gustavo Toledo, Silvia Carramao, Raphael Moreira, Carolina Jesus, Sarah Carvalho, Raquel Richetti, and Antônio Auge Susane HwangSusane Hwang More articles by this author , Luis Gustavo ToledoLuis Gustavo Toledo More articles by this author , Silvia CarramaoSilvia Carramao More articles by this author , Raphael MoreiraRaphael Moreira More articles by this author , Carolina JesusCarolina Jesus More articles by this author , Sarah CarvalhoSarah Carvalho More articles by this author , Raquel RichettiRaquel Richetti More articles by this author , and Antônio AugeAntônio Auge More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One quarter of women without urinary incontinence can develop de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP). This condition has been reported more frequently in women with occult SUI. However, studies are diverse as far as the investigation of occult SUI is concerned, and it has not been possible to reach a consensus on the benefits of preoperative urodynamics (UDS). The aim of this study was to investigate the impact of preoperative UDS on the surgical treatment of POP by analyzing whether performing UDS added diagnoses, modified surgical planning, and changed postoperative outcomes in women with advanced POP. METHODS: Retrospective observational study including women having POP stages III and IV, without symptoms of SUI, undergoing surgery for POP, between May 2015 and January 2020, with a minimum three-month follow-up period. Preoperative evaluation included the patients' standard clinical history, a physical examination (PE) to quantify genital prolapse, and stress testing with and without prolapse reduction at PE. Multi-channel UDS was performed when the surgeon so indicated. Postoperative outcomes were measured by excluding women with occult SUI on PE, and analyzing the incidence of de novo SUI, and need for a second approach for midurethral sling or urethrolysis. RESULTS: A total of 226 patients met the inclusion criteria, and 102 (45.1%) performed UDS. UDS added diagnoses in 64/102 (62.6%), having added 21/102 (20.6%) occult SUI cases. After UDS, there was a change in surgical procedure in 20/102 (19.6%) cases (18 indications for sling and two contraindications for it). The overall rate of occult SUI in the 226 patients was 28.8% (65/226). Among the 182 patients that were continent upon physical examination (PE), 68 (37.4%) underwent UDS. Postoperatively, patients in the UDS group maintained more urge incontinence (p=0.006) and storage symptoms (p<0.001) than the PE group. No statistical difference was found in the incidence of de novo SUI between the UDS group 6/68 (8.8%) and the PE group 11/114 (9.6%) (p=0.853), nor in the need of postoperative sling: 4/68 (5.9%) and 5/114 (4.4%), respectively. CONCLUSIONS: Preoperative UDS in women with POP stages III and IV increments diagnoses, changes surgical planning, increases the number of concomitant slings placement and does not change outcome in continent women upon PE. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e88 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susane Hwang More articles by this author Luis Gustavo Toledo More articles by this author Silvia Carramao More articles by this author Raphael Moreira More articles by this author Carolina Jesus More articles by this author Sarah Carvalho More articles by this author Raquel Richetti More articles by this author Antônio Auge More articles by this author Expand All Advertisement PDF downloadLoading ...