Pre-operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes

Philippe Zimmern, Heather Litman, Charles Nager, Larry Sirls, Stephen R. Kraus, Kimberly Kenton, Tracey Wilson, Gary Sutkin, Nazema Siddiqui, Sandip Vasavada, Peggy Norton

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Aims: To determine if pre-operative urodynamic testing (UDS) affects physicians' diagnostic confidence and if physician confidence affects treatment outcomes at 1 year. Methods: The Value of Urodynamic Evaluation (ValUE) trial randomized 630 women with predominant stress urinary incontinence (SUI) to office evaluation (OE) or OE plus UDS prior to surgery. After OE, physicians completed a checklist of five clinical diagnoses: SUI, overactive bladder (OAB) wet and dry, voiding dysfunction (VD), and intrinsic sphincter deficiency (ISD), and reported their confidence in each. Responses ranged from 1 to 5 with; 1 = "not very confident (<50%)" to 5 = "extremely confident (95 + %)." After UDS, investigators again rated their confidence in these five clinical diagnoses. Logistic regression analysis correlated physician confidence in diagnosis with treatment success. Results: Of 315 women who received OE plus UDS, 294 had complete data. Confidence improved after UDS in patients with baseline SUI (4.52-4.63, P < 0.005), OAB-wet (3.55-3.75, P < 0.001), OAB-dry (3.55-3.68 P < 0.005), VD (3.81-3.95, P < 0.005), and suspected ISD (3.63-3.92, P < 0.001). Increased confidence after UDS was not associated with higher odds of treatment success although mean changes in confidence were slightly higher for those who achieved treatment success. Physician diagnoses shifted more from not confident to confident for ISD and OAB-wet after UDS (McNemar's P-value <0.001 for both). Conclusions: In women undergoing UDS for predominant SUI, UDS increased physicians' confidence in their clinical diagnoses; however, this did not correlate with treatment success.

Original languageEnglish (US)
Pages (from-to)302-306
Number of pages5
JournalNeurourology and Urodynamics
Volume33
Issue number3
DOIs
StatePublished - 2014

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Stress Urinary Incontinence
Urodynamics
Physicians
Overactive Urinary Bladder
Therapeutics
Checklist
Logistic Models
Regression Analysis
Research Personnel

Keywords

  • incontinence
  • outcomes
  • urodynamics

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

Cite this

Pre-operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes. / Zimmern, Philippe; Litman, Heather; Nager, Charles; Sirls, Larry; Kraus, Stephen R.; Kenton, Kimberly; Wilson, Tracey; Sutkin, Gary; Siddiqui, Nazema; Vasavada, Sandip; Norton, Peggy.

In: Neurourology and Urodynamics, Vol. 33, No. 3, 2014, p. 302-306.

Research output: Contribution to journalArticle

Zimmern, P, Litman, H, Nager, C, Sirls, L, Kraus, SR, Kenton, K, Wilson, T, Sutkin, G, Siddiqui, N, Vasavada, S & Norton, P 2014, 'Pre-operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes', Neurourology and Urodynamics, vol. 33, no. 3, pp. 302-306. https://doi.org/10.1002/nau.22398
Zimmern, Philippe ; Litman, Heather ; Nager, Charles ; Sirls, Larry ; Kraus, Stephen R. ; Kenton, Kimberly ; Wilson, Tracey ; Sutkin, Gary ; Siddiqui, Nazema ; Vasavada, Sandip ; Norton, Peggy. / Pre-operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes. In: Neurourology and Urodynamics. 2014 ; Vol. 33, No. 3. pp. 302-306.
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AU - Zimmern, Philippe

AU - Litman, Heather

AU - Nager, Charles

AU - Sirls, Larry

AU - Kraus, Stephen R.

AU - Kenton, Kimberly

AU - Wilson, Tracey

AU - Sutkin, Gary

AU - Siddiqui, Nazema

AU - Vasavada, Sandip

AU - Norton, Peggy

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