Urodynamic Predictors Research Articles

Clinical and Urodynamic Predictors for Failure of Medical Management with Alpha Blockers in PBNO: A Retrospective Cohort Analysis

To evaluate the clinical and urodynamic variables that may predict the failure of alpha-blockers in PBNO patients. Alpha-blockers are useful as a treatment option in patients with Primary Bladder Neck Obstruction (PBNO). Non-responders need to undergo Bladder Neck Incision (BNI). Little is known about the predictive factors determining success of treatment. The was a retrospective study, spanning over a period of 8 years. PBNO was diagnosed in the presence of a Bladder Outlet Obstruction Index (BOOI) >40 with video-urodynamic evidence of obstruction at the bladder neck. The patients were initially managed with alpha-blockers (alfuzosin/tamsulosin) for 3 to 6 months, and BNI contemplated when pharmacotherapy failed. The patients with upper tract changes managed with upfront BNI or Clean Intermittent Catheterization (CIC) were excluded. The data for the International Prostate Symptom Score (IPSS), uroflowmetry, urodynamic studies, and ultrasonography of pre and post-treatment periods were reviewed. Treatment outcomes were defined as complete response (>50% improvement in Qmax and IPSS score) and partial response (30-50% improvement in Qmax and IPSS score) at 3 or 6 months. Ninety-nine patients were analyzed. 21 patients underwent BNI for the failure of medical management and 31 for recurrence of symptoms at a mean follow-up of 18.8±3.5 months (12-70 months). Independent predictors of failure of pharmacotherapy with alpha-blockers were age (p = 0.021), Pdet@Qmax (p = 0.015), and BOOI (p = 0.019). Alpha-blockers are more likely to fail in PBNO in younger patients generating higher voiding pressures and BOOI > 60.

Urodynamic predictors of daytime and night-time urinary incontinence for Florin and Padua intracorporeal robotic neobladders: Results from two tertiary-care centres at a mid-term follow-up

Urodynamic predictors of daytime and night-time urinary incontinence for Florin and Padua intracorporeal robotic neobladders: Results from two tertiary-care centres at a mid-term follow-up

Urodynamic Predictors for Voiding Recovery after Transurethral Resection of Prostate in Benign Prostatic Hyperplasia Patients with Significant Post-voiding Residual Urine

Urodynamic Predictors for Voiding Recovery after Transurethral Resection of Prostate in Benign Prostatic Hyperplasia Patients with Significant Post-voiding Residual Urine

Clinical and urodynamic predictors of Q-tip test urethral hypermobility.

Urodynamics and Q-tip test represent diagnostic tools for the assessment of stress urinary incontinence. The aim of the present study was to investigate the possibility to predict the Q-tip test urethral hypermobility on the basis of clinical and urodynamic parameters. We analyzed all women performed urodynamics between 2008 and 2016 presenting urodynamic stress urinary incontinence. Symptoms were collected by the Incontinence Questionnaire-Short Form Questionnaire. A total of 501 women presented urodynamic stress incontinence, of which 270 had urethral hypermobility, according to the Q-tip test. Patients with urethral hypermobility were younger (P<0.0001) and presented a more advanced anterior compartment descensus according to the POP-Q system (Aa point P=0.0155; Ba point P=0.0374), a higher detrusor pressure at maximum flow (P=0.0075) and maximum flow rate compared to controls. Age, Aa POP-Q point and detrusor pressure at maximum flow were found to be independent predictors of Q-tip test urethral hypermobility. However, the final model cannot be used as an effective predictor of the Q-tip test result.

Urodynamic predictors of de novo overactive bladder after single-incision sling.

To identify urodynamic predictors for de novo overactive bladder (OAB) after single-incision sling implantation. This retrospective study analyzed women with pure, urodynamically proven stress urinary incontinence, without OAB, between 2008 and 2015, in a university hospital. De novo OAB was investigated during clinical interviews. A total of 192 patients were analyzed; 21 patients with de novo OAB were considered as group A while 171 control patients formed group B. Univariate analysis demonstrated that patients with de novo OAB have the first desire to void at a lower bladder volume (124mL versus 160mL, P=0.0052), smaller maximum cystometric capacity (357mL versus 406mL, P=0.0061), lower maximum flow (17mL/s versus 23mL/s, P=0.0006), and higher bladder outlet obstruction index (BOOI; -11 versus -23, P=0.0022) compared with controls. According to multivariate analysis, maximum cystometric capacity (parameter estimate [PE]=0.008, P=0.04) and BOOI (PE=-0.029, P=0.01) were independent urodynamic predictors of de novo OAB. The final model showed good predictive accuracy (area under the curve=0.81). The present study identified maximum cystometric capacity and BOOI as independent predictors of de novo overactive bladder after single-incision sling implantation. Therefore, preoperative urodynamics may be useful to improve preoperative counseling and to tailor surgical treatment.

256 - Urodynamic predictors of surgical outcomes following male sling implantation

256 - Urodynamic predictors of surgical outcomes following male sling implantation

Clinical and Urodynamic Predictors of the Q-Tip Test in Women With Lower Urinary Tract Symptoms.

PurposeThe Q-tip test is used to measure urethral hypermobility and can predict surgical outcomes. However, certain factors may affect the reliability of this test. Our aim was to identify independent clinical and urodynamic predictors of the results of the Q-tip test.MethodsBetween January 2014 and June 2019, 176 consecutive women with lower urinary tract symptoms who underwent the Q-tip test and urodynamic studies were included in this retrospective study.ResultsMultivariable regression analysis revealed that age (regression coefficient, -0.55), point Ba (regression coefficient, 4.1), urodynamic stress incontinence (regression coefficient, 9.9), maximum flow rate (Qmax) (regression coefficient, 0.13), pressure transmission ratio (PTR) at maximum urethral pressure (MUP) (regression coefficient, -0.14), and the score on the fifth question of the Incontinence Impact Questionnaire (IIQQ5; “Has urine leakage affected your participation in social activities outside your home?”; regression coefficient, -4.1) were independent predictors of the Q-tip angle, with a constant of 87.0. The following Spearman rank correlation coefficients were found between the Q-tip angle and the following variables: age, -0.38; point Ba, 0.34; urodynamic stress incontinence, 0.32; Qmax, 0.28; PTR at MUP, -0.28; and IIQQ5, -0.23. A receiver operating characteristic curve (ROC) analysis for the prediction of urodynamic stress incontinence found that the optimum cutoff for PTR at MUP was <81%, with an area under the ROC curve of 0.70.ConclusionsAge, point Ba, urodynamic stress incontinence, Qmax, PTR at MUP, and IIQQ5 were independent predictors of the Q-tip angle. However, none of these could be used as effective surrogates for the Q-tip test due to their lack of a sufficient correlation.

PD04-10 DEMOGRAPHIC AND URODYNAMIC RISK ANALYSIS OF RENAL DETERIORATION IN SPINAL CORD INJURED PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2018PD04-10 DEMOGRAPHIC AND URODYNAMIC RISK ANALYSIS OF RENAL DETERIORATION IN SPINAL CORD INJURED PATIENTS Arthi Satyanarayan, Nabeel Shakir, Jessica Eastman, and Gary Lemack Arthi SatyanarayanArthi Satyanarayan More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Jessica EastmanJessica Eastman More articles by this author , and Gary LemackGary Lemack More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.288AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Though the risk of progressive renal insufficiency in patients with spinal cord injury (SCI) has decreased over the past several decades, it is clear that certain patients remain at risk. The purpose of this study was to assess predictors of renal deterioration in patients with SCI. METHODS We reviewed renal status in adult SCI patients from August 2001 to May 2015 after recovery from spinal shock using a prospectively maintained database. Patients with baseline renal ultrasound and/or serum creatinine (SCr) followed by urodynamic study (UDS) were included. Those with baseline abnormal renal function or no follow-up were excluded. Renal deterioration was defined as doubled SCr, 30% or more decrease in the estimated glomerular filtration rate (eGFR), new hydronephrosis, or renal atrophy. Demographic and UDS parameters were assessed in univariate and multivariable regression models to determine association with renal deterioration. RESULTS 98 patients met study criteria with median follow-up of 43 months.13/98 (13%) experienced renal deterioration: 9 by eGFR, 3 by imaging and 1 by both (Figure 1). Demographic factors and UDS parameters were not associated with renal deterioration (Table 1). 15 patients had altered compliance and were managed by indwelling catheter (3), intermittent catheterization (11), or spontaneous voiding (1). Patients with renal loss were not more likely to have altered compliance compared to those without (1/13 vs 14/87, p=0.7). CONCLUSIONS In SCI patients at a tertiary neurourology clinic, the rate of renal deterioration is modest, without associated demographic or urodynamic predictors. Though untreated intravesical pressure elevation may predict renal deterioration in SCI, our series suggests patients can maintain normal renal function given appropriate bladder management. Nonetheless, ongoing surveillance is recommended given that renal loss occurs, albeit at an improved rate compared to historical series. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e81 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Arthi Satyanarayan More articles by this author Nabeel Shakir More articles by this author Jessica Eastman More articles by this author Gary Lemack More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prospective Evaluation of Sacral Neuromodulation in Children: Outcomes and Urodynamic Predictors of Success

Sacral neuromodulation has been demonstrated to improve refractory bowel bladder dysfunction in children. The purpose of the current study was to determine whether results are durable in children after longer followup, whether children with a lower body mass index are at risk for device failure and whether pretreatment urodynamic evaluation can predict posttreatment outcome. Pediatric patients with refractory bowel bladder dysfunction were enrolled following informed consent and followed prospectively. All patients underwent preoperative videourodynamic evaluation and a 2-stage implantation procedure. Validated questionnaires were used to assess symptom severity and quality of life. Complications were analyzed with regard to treatment required and patient body mass index. During 45 months 30 patients were enrolled. Median age was 8.3 years at enrollment. Median followup was 14.8 months. Patients had significant improvement in quality of life and symptom scores, which persisted at the most recent followup. Patients who had uninhibited detrusor contractions on preoperative urodynamic assessment had significantly greater improvement in symptoms. Of the patients 23% had a complication requiring reoperation, most commonly neurostimulator lead breakage in those with a significantly lower body mass index. Sacral neuromodulation significantly improves quality of life and symptom severity in children with refractory bowel bladder dysfunction. Children gain greater benefit if they show uninhibited bladder contractions on preoperative urodynamic evaluation. Children have a high rate of lead breakage requiring operative revision, which was seen after minor trauma in those with a lower body mass index.

Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES:To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease.METHODS:In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated.RESULTS:Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment was the only predictor of the clinical response. Additionally, patients with a Unified Parkinson's Disease Rating Scale score lower than 70 had a significantly higher chance of clinical improvement with doxazosin treatment than those with higher Unified Parkinson's Disease Rating Scale scores did (RR = 3.10, 95% CI = [1.15 to 5.37], p = 0.011).CONCLUSIONS:Doxazosin resulted in the improvement of lower urinary tract symptoms and the maximum flow rate and was well tolerated in men with Parkinson's disease. The response to treatment is dependent on the severity of neurological disability.

Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence: a narrative review

Knowledge about clinical risk factors and the value of urodynamic testing is important to optimize treatment strategy and secure true informed consent. We reviewed the relevant literature to clarify the evidence regarding clinical risk factors and the predictive value of urodynamic testing in patients with urinary incontinence, where surgery is considered. Because of the paucity of evidence based on randomized controlled trials, we conducted a narrative review of the published literature. Clinical risk factors in terms of mixed urinary incontinence, previous incontinence surgery, body mass index (BMI) ≥ 35, age ≥ 75, and presence of diabetes mellitus were significantly related to decreased outcome of incontinence surgery. Furthermore, noninvasive and invasive urodynamic parameters indicating detrusor overactivity, voiding difficulties, low urethral pressure, and bladder-neck immobility were related to poorer outcome of surgery. This study summarized the available evidence regarding preoperative clinical risk factors and urodynamic parameters indicating decreased or adverse outcome of surgery, and this report also provides clinical recommendations.

Prospective Urodynamic Model for Prediction of Urinary Incontinence after Robot-Assisted Radical Prostatectomy

Objectives: To assess the preoperative urodynamic predictors of urinary incontinence (UI) 1 year after robot-assisted radical prostatectomy (RARP) and to design a nomogram capable of predicting its occurrence. Materials and Methods: Our prospective study included 58 previously continent patients who underwent RARP, in most cases, bilateral nerve-sparing and bladder neck preservation. A urodynamic examination including a urethral pressure profile was performed preoperatively. Multivariate analysis was used to assess the predictors for the need to use 1 or more pads/day and a nomogram was constructed. Results: There was a 20.6% incidence of UI at 1 year after RARP. Bladder compliance, maximum urethral closure pressure and the development of bladder outlet obstruction, correlated well with the incidence of UI on the multivariate analysis (p = 0.043, 0.001, and 0.05, respectively). Conclusion: Bladder compliance <27.8 ml/cm H₂O, maximum urethral closure pressure <50.3 cm H₂O and the bladder outlet obstruction are independent urodynamic factors correlating with UI after RARP. The new nomogram can objectively predict a patient likelihood of requiring 1 or more pads/day 1 year after RARP with a good accuracy.

Preoperative urodynamic predictors of short-term voiding dysfunction following a transobturator tension-free vaginal tape procedure

Objective To determine whether preoperative urodynamic parameters can predict the development of short-term voiding dysfunction (VD) after a transobturator tension-free vaginal tape (TO-TVT) procedure. Methods In a prospective study between April 2005 and April 2007, 341 women were randomized to receive “inside-out” or “outside-in” TO-TVT. The present secondary analysis included women who had completed a preoperative symptom questionnaire, had a voided volume of 100 mL or more on preoperative uroflowmetry, and underwent standardized postoperative voiding assessment. VD was defined as a requirement for postoperative catheterization. Univariate and multivariate analysis were done by SPSS 17. Results The inclusion criteria were met by 224 women, of whom 17 (7.6%) had postoperative VD. On univariate analysis, there were no differences in preoperative parameters among those with and those without VD: residual urine volume ( P = 0.485), peak flow rate on or below 5th centile ( P = 0.272), average flow rate on or below 5th centile ( P = 0.142), detrusor pressure at opening ( P = 0.955), maximum urethral closure pressure at 30 cm H 2O or less ( P = 0.855) and functional urethral length ( P = 0.173). None of the variables analyzed was an independent risk factor on multivariate analysis. Conclusion Preoperative urodynamic parameters did not predict the development of short-term voiding dysfunction after a TO-TVT procedure.

Long-Term Outcome of Transobturator Tension-Free Vaginal Tape: Efficacy and Risk Factors for Surgical Failure

To assess the 5-year efficacy of the inside-out transobturator tension-free vaginal tape (TVT-O) for the treatment of stress urinary incontinence (SUI) and to explore possible predictors for long-term failure. Sixty-five consecutive patients who underwent TVT-O were prospectively enrolled. Patients who required concomitant anterior or apical pelvic organ prolapse repair or both and those with urodynamic occult SUI were excluded. Postoperatively, patients were scheduled for evaluation at 1, 3, 6, and 12 months and annually thereafter. Surgical failure was defined as positive stress test, daily episodes of SUI, and negative global satisfaction. Preoperative and interim clinical and urodynamic predictors for long-term failure were analyzed from a computerized database. Sixty-one patients (mean age at surgery 56.6±10.2 years) completed 5 years of follow-up. Of these, 11 (18%) patients were classified as surgical failure, 5 (8%) as improved, and 45 (74%) as cured. Any SUI (100% vs. 10%, p=0.001), daily SUI (100% vs. 0%, p=0.001), overactive bladder (OAB) (100% vs. 48%, p=0.001), and the use of antimuscarinic drugs (64% vs. 26%, p=0.03) were found to be significantly more common among failure cases. Preoperative detrusor overactivity (odds ratio [OR] 7.6, 95% confidence interval [CI] 1.7-32.9), interim 1-year OAB (OR 20.5, 95% CI 1.9-215.4), and interim 1-year SUI (OR 26.4, 95% CI 1.5-475.2) were found to be significant independent risk factors for long-term surgical failure. An 18% rate of surgical failure was observed 5 years after TVT-O. Larger studies with longer follow-up periods may facilitate the identification of risk factors for failure and, thus, enable better preoperative consultation.

Sacral Neuromodulation in Children With Urinary and Fecal Incontinence: A Multicenter, Open Label, Randomized, Crossover Study

The clinical benefit of sacral neuromodulation is unclear due to the paucity of randomized trial data. The purpose of this study was to evaluate sacral neuromodulation for management of urinary and fecal incontinence in a pediatric population. This multicenter, open label, randomized, crossover study included children older than 5 years. After trial stimulation of the S3 root a neuromodulator (InterStim) was implanted on the S3 foramen. Clinical examinations, voiding and bowel diaries, and urodynamic and manometric evaluations were performed at the beginning (t1) and end (t2) of the first period, and at the beginning (t3) and end (t4) of the second period. A total of 33 patients (24 boys) with a mean +/- SD age of 12.22 +/- 5.09 years were randomized. Etiologies were mainly of neurological origin. Incontinence was mixed urinary and fecal in 19 cases, urinary only in 9 and fecal only in 5. Cystometric bladder capacity increased during sacral neuromodulation (delta +24.27 ml vs -37.45 ml, p = 0.01). There was no significant change in other urodynamic or manometric parameters. Overall positive response rate was more than 75% for urinary (81%) and bowel (78%) function. Crossover analysis indicated that sacral neuromodulation is more effective than conservative treatment for both types of incontinence (p = 0.001). In a pediatric population sacral neuromodulation is effective for bladder and bowel dysfunction and should be considered before irreversible surgery.

Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings

The objective of the study was to identify predictors of recurrent urinary incontinence (UI) 1 year after treatment with tension-free vaginal tape (TVT) and transobturator tape (TOT). One hundred sixty-two women with urodynamic stress urinary incontinence (SUI) were included in a clinical trial comparing TVT with TOT with at least 1 year of follow-up were included in this analysis. Potential clinical and urodynamic predictors for development of "any recurrent UI" or "recurrent SUI" 1 year after surgery were evaluated using logistic regression models. Subjects who received concurrent prolapse surgery and those taking anticholinergic medications preoperatively were more likely to develop any recurrent UI. Increasing age was independently associated with recurrent SUI. Risk factors were similar for TVT and TOT for both definitions of treatment failure. Concurrent prolapse surgery and preoperative anticholinergic medication use are associated with increased risk of developing recurrent UI 1 year after TVT or TOT. Increasing age is specifically associated with the recurrence of SUI symptoms.

Normal Preoperative Urodynamic Testing Does Not Predict Voiding Dysfunction After Burch Colposuspension Versus Pubovaginal Sling

Urodynamic studies have been proposed as a means of identifying patients at risk for voiding dysfunction after surgery for stress urinary incontinence. We determined if preoperative urodynamic findings predict postoperative voiding dysfunction after pubovaginal sling or Burch colposuspension. Data were analyzed from preoperative, standardized urodynamic studies performed on participants in the Stress Incontinence Treatment Efficacy Trial, in which women with stress urinary incontinence were randomized to undergo pubovaginal sling surgery or Burch colposuspension. Voiding dysfunction was defined as use of any bladder catheter after 6 weeks, or reoperation for takedown of a pubovaginal sling or Burch colposuspension. Urodynamic study parameters examined were post-void residual urine, maximum flow during noninvasive flowmetry, maximum flow during pressure flow study, change in vesical pressure at maximum flow during pressure flow study, change in abdominal pressure at maximum flow during pressure flow study and change in detrusor pressure at maximum flow during pressure flow study. The study excluded women with a preoperative post-void residual urine volume of more than 150 ml or a maximum flow during noninvasive flowmetry of less than 12 ml per second unless advanced pelvic prolapse was also present. Of the 655 women in whom data were analyzed voiding dysfunction developed in 57 including 8 in the Burch colposuspension and 49 in the pubovaginal sling groups. There were 9 patients who could not be categorized and, thus, were excluded from the remainder of the analysis (646). A total of 38 women used a catheter beyond week 6, 3 had a surgical takedown and 16 had both. All 19 women who had surgical takedown were in the pubovaginal sling group. The statistical analysis of urodynamic predictors is based on subsets of the entire cohort, including 579 women with preoperative uroflowmetry, 378 with change in vesical pressure, and 377 with change in abdominal and detrusor pressure values. No preoperative urodynamic study findings were associated with an increased risk of voiding dysfunction in any group. Mean maximum flow during noninvasive flowmetry values were similar among women with voiding dysfunction compared to those without voiding dysfunction in the entire group (23.4 vs 25.7 ml per second, p = 0.16), in the Burch colposuspension group (25.8 vs 25.7 ml per second, p = 0.98) and in the pubovaginal sling group (23.1 vs 25.7 ml per second, p = 0.17). Voiding pressures and degree of abdominal straining were not associated with postoperative voiding dysfunction. In this carefully selected group preoperative urodynamic studies did not predict postoperative voiding dysfunction or the risk of surgical revision in the pubovaginal sling group. Our findings may be limited by the stringent exclusion criteria and studying a group believed to be at greater risk for voiding dysfunction could alter these findings. Additional analysis using subjective measures to define voiding dysfunction is warranted to further determine the ability of urodynamic studies to stratify the risk of postoperative voiding dysfunction, which appears to be limited in the current study.

Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A Single Center Experience With 20 Children

Recent advances in neuromodulation have demonstrated promise in treating children with the dysfunctional elimination syndrome refractory to medical management. Sacral nerve stimulation with the InterStim implantable device has been used in adults for management of chronic urinary complaints. However, there are few data regarding the usefulness of sacral nerve stimulation in children. We report our experience with sacral nerve stimulation for severe dysfunctional elimination syndrome. A total of 20 patients 8 to 17 years old with the dysfunctional elimination syndrome refractory to maximum medical treatment underwent sacral nerve stimulation at our institution. Patients were followed prospectively for a median of 27 months after the procedure. Urinary incontinence, urgency and frequency, nocturnal enuresis and constipation were improved or resolved in 88% (14 of 16), 69% (9 of 13), 89% (8 of 9), 69% (11 of 16) and 71% (12 of 17) of the patients, respectively. Urinary retention requiring intermittent catheterization persisted in 75% of the patients (3 of 4) despite sacral nerve stimulation. Complications requiring operative treatment occurred in 20% of the patients (4 of 20). Following marked symptomatic improvement 2 devices were explanted at 20 and 19 months following placement, and both patients have remained symptom-free. Sacral nerve stimulation is effective in the majority of our patients, and should be considered in children with severe dysfunctional elimination syndrome refractory to maximum medical treatment.

Urodynamic Measures Do Not Predict Stress Continence Outcomes After Surgery for Stress Urinary Incontinence in Selected Women

We determined the prognostic value of preoperative urodynamic results in patients with stress urinary incontinence. In a 9-center surgical trial, women with stress urinary incontinence were randomized to a Burch or pubovaginal sling procedure. Women were eligible for the study if they had predominant stress urinary incontinence symptoms, a positive cough stress test, a bladder capacity more than 200 ml and urethral hypermobility. Preoperative free uroflowmetry, filling cystometry and pressure flow studies were performed in all. Overall treatment success required a negative pad test, no urinary incontinence on a 3-day diary, a negative stress test, no self-reported stress urinary incontinence symptoms and no re-treatment for stress urinary incontinence. Stress specific success required all of the last 3 criteria. We examined urodynamic measures, and whether the presence of urodynamic stress incontinence, the presence of detrusor overactivity and Valsalva leak point pressure would predict surgical success. Subjects with urodynamic stress incontinence had a 2-fold greater odds of overall success when compared with the No urodynamic stress incontinence group, but this trend did not quite reach statistical significance (OR 2.26; 95% C.I. 0.99, 5.17). Odds of stress specific success did not differ by urodynamic stress incontinence status. Subjects with detrusor overactivity did not have significantly worse success rates. Stratifying by treatment group, there was no difference in mean Valsalva leak point pressure values between surgical successes and failures. We found a nearly statistically significant trend that women with urodynamic stress incontinence are twice as likely to have a successful overall outcome from surgical management of stress urinary incontinence as women without urodynamic stress incontinence. The level of Valsalva leak point pressure and the presence of detrusor overactivity do not predict the success outcomes after the Burch or autologous fascia sling procedures in women with pure or predominant stress urinary incontinence. The impact of urodynamic studies on surgical outcomes needs further investigation.

Urodynamic predictors of outcomes with photoselective laser vaporization prostatectomy in patients with benign prostatic hyperplasia and preoperative retention

Objectives To determine whether preoperative urodynamic parameters can predict the outcome in men in urinary retention and aid in counseling these men. Methods Forty men in urinary retention due to benign prostatic hyperplasia underwent photoselective laser vaporization prostatectomy (PVP). Preoperative urodynamic studies were used to identify the men with detrusor overactivity (DO) and impaired detrusor contractility (IDC). The International Prostate Symptom Score (IPSS), maximal flow rate, and postvoid residual urine volume were collected at 1, 3, 6, and 12 months after PVP. Results Of the 40 men, 8 (20%) had IDC and 30 had DO (75%) preoperatively. The men without preoperative DO had a significantly lower IPSS than those with preoperative DO at 1 month of follow-up. Men without preoperative IDC had a significantly lower IPSS and postvoid residual urine volume at the same point compared with men with preoperative IDC. The flow rate in men with preoperative IDC 1 and 6 months postoperatively was significantly lower than in men without preoperative IDC. Conclusions Preoperative urodynamic parameters predict for outcome in men in urinary retention undergoing PVP. Men in urinary retention benefit from PVP with an improvement in both subjective and objective voiding function, regardless of the presence of DO or IDC. Postoperatively, patients with DO have more voiding symptoms than those without DO, and are almost twice as likely to require anticholinergics. Men without IDC have better IPSS, flow rates, and postvoid residual urine volumes compared with men with IDC. Of the 8 men with IDC, 3 required reoperation within the first year.