Elsevier

Urology

Volume 55, Issue 4, April 2000, Pages 506-511
Urology

Adult Urology
Identifying patients who require urodynamic testing before surgery for stress incontinence based on questionnaire information and surgical history

https://doi.org/10.1016/S0090-4295(99)00546-4Get rights and content

Abstract

Objectives. To determine whether knowledge about previous surgical history for incontinence and responses to a validated lower urinary tract symptom questionnaire for women could identify those who should undergo urodynamic testing before surgery for stress urinary incontinence (SUI).

Methods. A retrospective analysis of all women who completed the Urogenital Distress Inventory-6 questionnaire (UDI-6) and then underwent complete urodynamic studies was conducted. The critical urodynamic diagnoses to determine before anti-incontinence surgery were defined as coexisting SUI and detrusor instability (DI), Valsalva leak point pressure less than 60 cm H2O, and DI alone in women suspected clinically of having SUI. Models were established for deciding who should undergo urodynamic studies on the basis of questionnaire responses and information about previous surgical history. Cost savings and the ability of the various models to identify patients with critical urodynamic diagnoses were calculated.

Results. A total of 174 women completed the UDI-6 and underwent urodynamics studies. Sixty-two had SUI (36%), 54 had DI (31%), 18 had both SUI and DI (10%), and 19 women suspected of having SUI were found instead to have DI (11%). Among women with SUI, 39 had a Valsalva leak point pressure less than 60 cm H2O (63%). No group of question responses or combination of question responses and presence of previous incontinence surgery was able to identify all three critical urodynamic diagnoses with statistical significance. Still, the combination of a response of “2” or “3” to question 3 on the UDI-6 and a positive history of previous surgery would have identified 91% of the critical diagnoses, and a substantial cost savings would have been realized.

Conclusions. Using the UDI-6 and information obtained from the patient’s history to determine who should undergo urodynamic testing before surgery for SUI can result in substantial cost savings without sacrificing patient care.

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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