Adult UrologyIdentifying patients who require urodynamic testing before surgery for stress incontinence based on questionnaire information and surgical history
Section snippets
Material and methods
From July 1997 until March 1999, women presenting to our clinic for incontinence and voiding dysfunction were asked to complete the short form of the UDI-6.6 Nearly all women then underwent multichannel urodynamic studies before treatment options were discussed. In this study, we report on all women who completed the UDI-6 and underwent urodynamic studies during this period. Information about previous anti-incontinence operations was obtained at the original visit when the questionnaire was
Results
A total of 174 consecutive women completed the UDI-6 and underwent urodynamic studies within the next month. Of these women, 62 had SUI demonstrated during the urodynamic evaluation. The mean VLPP was 50.9 ± 21.4 cm H2O (median 51). Of those who had SUI, 18 (29%) were found to have concomitant DI, and 36 (32%) of the 112 without SUI had DI on urodynamic evaluation. The most common chief complaints are presented in Table II, and stratified by the presence or absence of SUI during the urodynamic
Comment
The value of urodynamic studies in cases of complex incontinence, such as with neurologic disease or after complex pelvic surgery, is unquestioned. However, its value in patients with a primary complaint of SUI, with or without previous incontinence surgery, is controversial. This is particularly true given recent reports that suggest all forms of SUI be treated similarly and that certain urodynamic diagnoses can be predicted by questionnaire data or physical examination alone.5, 9 On the basis
Conclusions
We tested the ability of a lower urinary tract questionnaire to identify patients with specific urodynamic diagnoses that might be valuable in directing therapy and offering prognostic information before surgery for SUI. These critical diagnoses included coexisting SUI and DI, a VLPP less than 60 cm H2O, and the presence of DI but not SUI in women suspected to have SUI. No questionnaire response could identify each group of critical urodynamic diagnoses with statistical significance. However,
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