Nov
Beyond the Abstract – Do women with pure stress urinary incontinence need urodynamics?
From UroToday
by G. Alessandro Digesu, MD
| Monday, 19 October 2009 | |
| BERKELEY, CA (UroToday.com) – There is on-going debate among professional bodies world-wide regarding the standard assessment for women with stress urinary incontinence, especially for those who are considered for surgical treatment. This debate mainly involves both the clinical need and cost effectiveness of urodynamic assessment in this group of women.
In our study, the data for 3428 women aged 24 to 81 years, with urinary incontinence, were collected retrospectively from the year 2000 to 2007. All women were studied using a frequency volume chart, a validated symptom assessment tool (King’s Health Questionnaire), as well as urodynamics assessment, which was analysed separately. Out of the total population, only 308 women (8.9%) presented “pure” stress urinary incontinence. Of these, 78.2% had urodynamic stress incontinence, 7.5% had detrusor overactivity, 2.9% had mixed urinary incontinence and 11.4% had no urodynamic abnormality; of the latter, many were found to have detrusor overactivity on ambulatory urodynamics. Finally up to 8% of women had post void residual volumes greater than 100 ml. The correlation between severity and mechanism of incontinence, based on symptoms and voiding diary and assessed by urodynamics, was weak. In conclusion, urodynamics provide useful information in the assessment of women with history of pure SUI, since up to 20% of them might not need surgery as the first-line treatment. This article contributes key aspects to the debate by clearly highlighting the value of urodynamic assessment in women suffering from pure stress urinary incontinence symptoms. This study further supports previous data reported by the Bristol Urological Institute about the care needed to ensure that women are aware that symptoms may not give the full urodynamic picture and indicates the potential pitfalls of surgery where diagnosis is not fully accurate. Where urodynamics is omitted, a comprehensive clinical evaluation, including flow rate and post-void residual measurement is essential to exclude overactive bladder symptoms or voiding dysfunction. Written by: |