Effect of Preoperative Urodynamic Study on Urinary Outcomes after Transobturator Sling

 

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Abstract

Objective To evaluate whether performing preoperative urodynamic study influences postoperative urinary symptoms of women with stress urinary incontinence that underwent transobturator sling.

Methods Retrospective analysis of patients treated for stress urinary incontinence by transobturator sling from August 2011 to October 2018. Predictor variables included preoperative urodynamic study, age, incontinence severity, body mass index, preoperative storage symptoms and previous anti-urinary incontinence procedure. Outcome variables were postoperative subjective continence status, storage symptoms and complications. Logistic regression after propensity score was employed to compare outcomes between patients who underwent or not pre-operative urodynamic study.

Results The present study included 88 patients with an average follow-up of 269 days. Most patients (n = 52; 59.1%) described storage symptoms other than stress urinary incontinence, and 38 patients (43.2%) underwent preoperative urodynamic studies. Logistic regression after propensity score did not reveal an association between urinary continence outcomes and performance of preoperative urodynamic study (odds ratio 0.57; confidence interval [CI]: 0.11–2.49). Among women that did not undergo urodynamic study, there was a subjective improvement in urinary incontinence in 92% of the cases versus 87% in those that underwent urodynamic study (p = 0.461). Furthermore, postoperative storage symptoms were similar between women who did not undergo urodynamic study and those who underwent urodynamic study, 13.2% versus 18.4%, respectively (p = 0.753).

Conclusion Preoperative urodynamic study had no impact on urinary incontinence cure outcomes as well as on urinary storage symptoms after the transobturator sling in women with stress urinary incontinence.

Resumo

Objetivo Avaliar a influência do estudo urodinâmico pré-operatório nos resultados miccionais pós-operatórios em mulheres com incontinência urinária de esforço submetidas a sling transobturador.

Métodos Análise retrospectiva de mulheres com incontinência urinária de esforço submetidas a sling transobturador entre agosto de 2011 e outubro de 2018. As variáveis preditoras pré-operatórias, entre outras, foram a realização do estudo urodinâmico, gravidade da incontinência e sintomas urinários de armazenamento. As variáveis de desfecho pós-operatórias foram o status subjetivo da continência, sintomas de armazenamento urinário e complicações cirúrgicas. A regressão logística após o escore de propensão foi empregada para comparar os resultados entre os pacientes que foram submetidos ou não ao estudo urodinâmico pré-operatório.

Resultados Foram incluídas no presente estudo 88 pacientes com um seguimento médio de 269 dias. A maioria das pacientes apresentava sintomas miccionais de armazenamento (n = 52; 59,1%) concomitantes à incontinência urinária de esforço. Um pouco menos da metade das pacientes (n = 38; 43,2%) foram submetidas a estudo urodinâmico pré-operatório. A regressão logística após o escore de propensão não revelou associação entre os resultados de continência urinária e a realização de estudo urodinâmico pré-operatório (odds ratio 0,57; intervalo de confiança [IC]: 0,11–2,49). Além disso, os sintomas de armazenamento urinário pós-operatórios foram similares entre as pacientes que não realizaram e aquelas que realizaram o estudo urodinâmico, 13,2% e 18,4% respectivamente (p = 0,753).

Conclusão O estudo urodinâmico pré-operatório não teve impacto nos resultados de continência urinária, bem como nos sintomas de armazenamento urinário após o sling transobturatório.

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.

Publication History

Received: 20 May 2020

Accepted: 21 September 2020

Article published online:
19 January 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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• References

• 1 Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J. Pelvic Floor Disorders Network. et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008; 300 (11) 1311-1316 DOI: 10.1001/jama.300.11.1311.
  CrossrefPubMedGoogle Scholar
• 2 Dooley Y, Kenton K, Cao G. et al. Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. J Urol 2008; 179 (02) 656-661 DOI: 10.1016/j.juro.2007.09.081.
  CrossrefPubMedGoogle Scholar
• 3 Plagakis S, Tse V. The autologous pubovaginal fascial sling: An update in 2019. Low Urin Tract Symptoms 2020; 12 (01) 2-7 DOI: 10.1111/luts.12281.
  CrossrefPubMedGoogle Scholar
• 4 Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 1996; 7 (02) 81-85 , discussion 85–86 DOI: 10.1007/BF01902378.
  CrossrefPubMedGoogle Scholar
• 5 Petros PP. The intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence in the female. Aust N Z J Obstet Gynaecol 1996; 36 (04) 453-461 DOI: 10.1111/j.1479-828X.1996.tb02192.x.
  CrossrefPubMedGoogle Scholar
• 6 Delorme E, Droupy S, de Tayrac R, Delmas V. Transobturator tape (Uratape): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 2004; 45 (02) 203-207 DOI: 10.1016/j.eururo.2003.12.001.
  CrossrefPubMedGoogle Scholar
• 7 Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A. et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU Guideline. J Urol 2017; 198 (04) 875-883 DOI: 10.1016/j.juro.2017.06.061.
  CrossrefPubMedGoogle Scholar
• 8 Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A. et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol 2018; 73 (04) 596-609 DOI: 10.1016/j.eururo.2017.12.031.
  CrossrefPubMedGoogle Scholar
• 9 Serati M, Agrò EF. Urodynamics before surgery for stress urinary incontinence: the urodynamic examination is still one of the best friends of the surgeon and of patients with stress urinary incontinence. Eur Urol Focus 2016; 2 (03) 272-273 DOI: 10.1016/j.euf.2015.10.006.
  CrossrefPubMedGoogle Scholar
• 10 Serati M, Braga A, Torella M, Soligo M, Finazzi-Agro E. The role of urodynamics in the management of female stress urinary incontinence. Neurourol Urodyn 2019; 38 (Suppl. 04) S42-S50 DOI: 10.1002/nau.23865.
  CrossrefPubMedGoogle Scholar
• 11 Clement KD, Lapitan MC, Omar MI, Glazener CM. Urodynamic studies for management of urinary incontinence in children and adults: A short version Cochrane systematic review and meta-analysis. Neurourol Urodyn 2015; 34 (05) 407-412 DOI: 10.1002/nau.22584.
  CrossrefPubMedGoogle Scholar
• 12 Rodrigues FR, Maroccolo Filho R, Maroccolo RR, Paiva LC, Diaz FA, Ribeiro EC. Pubovaginal sling with a low-cost polypropylene mesh. Int Braz J Urol 2007; 33 (05) 690-694 DOI: 10.1590/S1677-55382007000500011.
  CrossrefPubMedGoogle Scholar
• 13 ElSheemy MS, Elsergany R, ElShenoufy A. Low-cost transobturator vaginal tape inside-out procedure for the treatment of female stress urinary incontinence using ordinary polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 2015; 26 (04) 577-584 DOI: 10.1007/s00192-014-2552-1.
  CrossrefPubMedGoogle Scholar
• 14 R Core Team. The R Project for Statistical Computing [Internet]. Vienna: The R Foundation; 2019. [cited 2010 Jan 12]. Available from: https://www.R-project.org/
  Google Scholar
• 15 Nager CW, Brubaker L, Litman HJ, Zyczyinski HM, Varner E, Amundsen C. Urinary Incontinence Treatment Network. et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 2012; 366 (21) 1987-1997 DOI: 10.1056/NEJMoa1113595.
  CrossrefPubMedGoogle Scholar
• 16 Norton PA, Nager CW, Brubaker L, Lemack GE, Sirls LT, Holley R. Urinary Incontinence Treatment Network. et al. The cost of preoperative urodynamics: A secondary analysis of the ValUE trial. Neurourol Urodyn 2016; 35 (01) 81-84 DOI: 10.1002/nau.22684.
  CrossrefPubMedGoogle Scholar
• 17 Rachaneni S, Latthe P. Does preoperative urodynamics improve outcomes for women undergoing surgery for stress urinary incontinence? A systematic review and meta-analysis. BJOG 2015; 122 (01) 8-16 DOI: 10.1111/1471-0528.12954.
  CrossrefPubMedGoogle Scholar
• 18 Linder BJ, Trabuco EC, Gebhart JB, Klingele CJ, Occhino JA, Elliott DS, Lightner DJ. et al. Can Urodynamic parameters predict sling revision for voiding dysfunction in women undergoing synthetic midurethral sling placement?. Female Pelvic Med Reconstr Surg 2019; 25 (01) 63-66 DOI: 10.1097/spv.0000000000000521.
  CrossrefPubMedGoogle Scholar
• 19 Serati M, Topazio L, Bogani G, Constantini E, Pietropaolo A, Palleschi G. et al. Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database. Neurourol Urodyn 2016; 35 (07) 809-812 DOI: 10.1002/nau.22804.
  CrossrefPubMedGoogle Scholar
• 20 Rubilotta E, Balzarro M, D'Amico A, Cerruto MA, Bassi S, Bovo C. et al. Pure stress urinary incontinence: analysis of prevalence, estimation of costs, and financial impact. BMC Urol 2019; 19 (01) 44 DOI: 10.1186/s12894-019-0468-2.
  CrossrefPubMedGoogle Scholar
• 21 van Leijsen SA, Kluivers KB, Mol BW, Hout JIT, Milani AL, Roovers JWR. Dutch Urogynecology Consortium. et al. Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial. Obstet Gynecol 2013; 121 (05) 999-1008 DOI: 10.1097/AOG.0b013e31828c68e3.
  CrossrefPubMedGoogle Scholar
• 22 deTayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanèse-Benamour L, Fernandez H. A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 2004; 190 (03) 602-608 DOI: 10.1016/j.ajog.2003.09.070.
  CrossrefPubMedGoogle Scholar
• 23 Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017; 7 (07) CD006375 DOI: 10.1002/14651858.CD006375.pub3.
  CrossrefPubMedGoogle Scholar
• 24 Imamura M, Hudson J, Wallace SA, MacLennan G, Shimonovich M, Omar MI. et al. Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials. BMJ 2019; 365: l1842 DOI: 10.1136/bmj.l1842.
  CrossrefPubMedGoogle Scholar
• 25 Elgamasy AK, Elashry OM, Elenin MA, Eltatawy HH, Elsharaby MD. The use of polypropylene mesh as a transobturator sling for the treatment of female stress urinary incontinence (early experience with 40 cases). Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (06) 833-838 DOI: 10.1007/s00192-007-0539-x.
  CrossrefPubMedGoogle Scholar
• 26 Yokoyama T, Nozaki K, Nose H, Inoue M, Nishiyama Y, Kumon H. Tolerability and morbidity of urodynamic testing: a questionnaire-based study. Urology 2005; 66 (01) 74-76 DOI: 10.1016/j.urology.2005.01.027.
  CrossrefPubMedGoogle Scholar
• 27 Brostrom S, Jennum P, Lose G. Morbidity of urodynamic investigation in healthy women. Int Urogynecol J Pelvic Floor Dysfunct 2002; 13 (03) 182-184 , discussion 184 DOI: 10.1007/s192-002-8349-9.
  CrossrefPubMedGoogle Scholar