Urodynamic assessment of urinary incontinence

Abstract

ContextUrodynamic evaluation in the assessment of women complaining of urinary incontinence remains controversial with recent UK National Institute of Health and Clinical Excellence guidance maintaining that it is unnecessary prior to surgery for women with a primarily stress leakage. Other experts contend it should be part of routine preoperative assessment since it establishes a diagnosis, allows more careful patient counseling and predicts surgical outcome.ObjectivesTo summarize current literature to define the evidence level on which these conflicting opinions are based.Materials and MethodsA systematic literature search was performed and retrieved publications summarized in a narrative evidence review using both original papers and previous reviews.ResultsFive hundred and one primary research papers and 65 previous reviews were retrieved. The findings were summarized in a narrative comprising overview, description of methods of bladder and urethral pressure measurement, and a summary of the literature concerning four key questions.ConclusionThe level of evidence was low regarding answering each of the questions posed, preventing firm conclusions. Urodynamic findings do correlate with relevant symptoms and, to some extent, with symptom severity, giving reasonable diagnostic accuracy. There is no reliable evidence that preoperative urodynamic diagnosis improves outcome from surgery for stress incontinence although it is likely to facilitate preoperative discussion. Tests to differentiate sphincter deficiency and urethral hypermobility are not currently recommended due to poor validity and reproducibility. This along with the current use of mid-urethral tapes as the universal primary surgical procedure means differentiation is not a necessity. Preoperative diagnosis of detrusor overactivity does not appear to worsen surgical outcome in women with a primary symptom of stress leakage. Large, well-designed prospective studies are now underway to provide a definitive answer to these questions.

Urodynamic Values Role For Females With Different Types Of Urinary Incontinence

“…Ineffective treatment of SUI cannot always be attributed to the procedure itself, but also to inappropriate choice of treatment in each particular case, even if the UI type is correctly established. In other studies it is also mentioned that the UDS do not have any clinical and economical value for isolated SUI prior to surgery, but we have to bear in mind that analysed patient group in these studies was isolated SUI [9,15,16]. At the same time, UDS is highly recommended at a recurrent UI after surgical treatment.…”

Animal Models of Double Incontinence: “Fecal and Urinary”

“…Blaivis type 3 SUI is with VLPP < 60 cm water, also known as intrinsic sphincter deficiency (ISD). In addition, a urethral pressure profile (UPP which is urethral pressuredetrusor pressure) < 20 cm water is also seen in the cases of ISD [12]. Animal models that simulate SUI provide an assessment of the mechanism of risk factors, including childbirth injuries, preclinical testing of new treatments and therapies for SUI.…”

The Effect of Duration of Stress Urinary Incontinence on developing Signs of Bladder Outlet Obstruction in Urodynamic Study

“…The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. [5] Urodynamics focuses on improving our knowledge of lower urinary tract function and identify the mechanism underlying the patient's symptoms. The information collected by urodynamics may corroborate or change the clinical diagnosis, which is based on medical records and physical examination, as well as impact the therapeutic decision.…”