The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery

Larry T. Sirls, Holly E. Richter, Heather J. Litman, Kimberly Kenton, Gary E. Lemack, Emily S. Lukacz, Stephen R. Kraus, Howard B. Goldman, Alison Weidner, Leslie Rickey, Peggy Norton, Halina M. Zyczynski, John W. Kusek

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Purpose: We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence. Materials and Methods: We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test. Results: Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004). Conclusions: Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.

Original languageEnglish (US)
Pages (from-to)204-209
Number of pages6
JournalJournal of Urology
Volume189
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Stress Urinary Incontinence
Urodynamics
Therapeutics
Overactive Urinary Bladder
Suburethral Slings
Physicians
Urge Urinary Incontinence
Urinary Incontinence
Multicenter Studies

Keywords

  • diagnosis
  • suburethral slings
  • urinary bladder overactive
  • urinary incontinence stress
  • urodynamics

ASJC Scopus subject areas

  • Urology

Cite this

The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery. / Sirls, Larry T.; Richter, Holly E.; Litman, Heather J.; Kenton, Kimberly; Lemack, Gary E.; Lukacz, Emily S.; Kraus, Stephen R.; Goldman, Howard B.; Weidner, Alison; Rickey, Leslie; Norton, Peggy; Zyczynski, Halina M.; Kusek, John W.

In: Journal of Urology, Vol. 189, No. 1, 01.2013, p. 204-209.

Research output: Contribution to journalArticle

Sirls, LT, Richter, HE, Litman, HJ, Kenton, K, Lemack, GE, Lukacz, ES, Kraus, SR, Goldman, HB, Weidner, A, Rickey, L, Norton, P, Zyczynski, HM & Kusek, JW 2013, 'The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery', Journal of Urology, vol. 189, no. 1, pp. 204-209. https://doi.org/10.1016/j.juro.2012.09.050
Sirls, Larry T. ; Richter, Holly E. ; Litman, Heather J. ; Kenton, Kimberly ; Lemack, Gary E. ; Lukacz, Emily S. ; Kraus, Stephen R. ; Goldman, Howard B. ; Weidner, Alison ; Rickey, Leslie ; Norton, Peggy ; Zyczynski, Halina M. ; Kusek, John W. / The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery. In: Journal of Urology. 2013 ; Vol. 189, No. 1. pp. 204-209.
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abstract = "Purpose: We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence. Materials and Methods: We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test. Results: Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8{\%}), decreasing the diagnoses of overactive bladder-wet (41.6{\%} to 25.2{\%}, p <0.001), overactive bladder-dry (31.4{\%} to 20.8{\%}, p = 0.002) and intrinsic sphincter deficiency (19.4{\%} to 12.6{\%}, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2{\%} to 11.9{\%}, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4{\%}), changed the incontinence procedure in 13 (4.4{\%}) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8{\%}). Nonoperative treatment plans changed in 40 of 294 women (14{\%}). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95{\%} CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95{\%} CI 1.46, 7.14, p = 0.004). Conclusions: Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.",
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AU - Lemack, Gary E.

AU - Lukacz, Emily S.

AU - Kraus, Stephen R.

AU - Goldman, Howard B.

AU - Weidner, Alison

AU - Rickey, Leslie

AU - Norton, Peggy

AU - Zyczynski, Halina M.

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N2 - Purpose: We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence. Materials and Methods: We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test. Results: Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004). Conclusions: Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.

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