Urodynamic changes associated with successful stress urinary incontinence surgery: is a little tension a good thing?
Stephen R Kraus, Gary E Lemack, Larry T Sirls, Toby C Chai, Linda Brubaker, Michael Albo, Wendy W Leng, L Keith Lloyd, Peggy Norton, Heather J Litman, Urinary Incontinence Treatment Network, Elizabeth A Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Thomas Rozanski, Peggy Norton, Ingrid Nygaard, Sharon Tennstedt, Anne Stoddard, Debuene Chang, Marva Moxey-Mims, Rebekah Rasooly, Amy Arisco, Jan Baker, Diane Borello-France, Kathryn L Burgio, Ananias Diokno, Melissa Fischer, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Margie Kahn, Jerry Lowder, Karl Luber, Emily Luckacz, Alayne Markland, Shawn Menefee, Pamela Moalli, Elizabeth Mueller, Pradeep Nagaraju, Kenneth Peters, Elizabeth Sagan, Joseph Schaffer, Amanda Simsiman, Robert Starr, Gary Sutkin, R Edward Varner, Laura Burr, Joann Columbo, Tamara Dickinson, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, D Lynn Kalinoski, Barbara Leemon, Kristen Mangus, Karen Mislanovich, Elva Kelly Moore, Caren Prather, Sylvia Sluder, Mary Tulke, Robin Willingham, Kimberly Woodson, Gisselle Zazueta-Damian, Kimberly J Dandreo, Liyuan Huang, Rose Kowalski, Heather Litman, Marina Mihova, Anne Stoddard, Kerry Tanwar, Sharon Tennstedt, Yan Xu, J Quentin Clemens, Paul Abrams, Diedre Bland, Timothy B Boone, John Connett, Dee Fenner, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters, Stephen R Kraus, Gary E Lemack, Larry T Sirls, Toby C Chai, Linda Brubaker, Michael Albo, Wendy W Leng, L Keith Lloyd, Peggy Norton, Heather J Litman, Urinary Incontinence Treatment Network, Elizabeth A Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Harry W Johnson, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Thomas Rozanski, Peggy Norton, Ingrid Nygaard, Sharon Tennstedt, Anne Stoddard, Debuene Chang, Marva Moxey-Mims, Rebekah Rasooly, Amy Arisco, Jan Baker, Diane Borello-France, Kathryn L Burgio, Ananias Diokno, Melissa Fischer, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Margie Kahn, Jerry Lowder, Karl Luber, Emily Luckacz, Alayne Markland, Shawn Menefee, Pamela Moalli, Elizabeth Mueller, Pradeep Nagaraju, Kenneth Peters, Elizabeth Sagan, Joseph Schaffer, Amanda Simsiman, Robert Starr, Gary Sutkin, R Edward Varner, Laura Burr, Joann Columbo, Tamara Dickinson, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, D Lynn Kalinoski, Barbara Leemon, Kristen Mangus, Karen Mislanovich, Elva Kelly Moore, Caren Prather, Sylvia Sluder, Mary Tulke, Robin Willingham, Kimberly Woodson, Gisselle Zazueta-Damian, Kimberly J Dandreo, Liyuan Huang, Rose Kowalski, Heather Litman, Marina Mihova, Anne Stoddard, Kerry Tanwar, Sharon Tennstedt, Yan Xu, J Quentin Clemens, Paul Abrams, Diedre Bland, Timothy B Boone, John Connett, Dee Fenner, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters
Abstract
Objective: To identify urodynamic changes that correlate with successful outcomes after stress urinary incontinence (SUI) surgery.
Methods: Six-hundred fifty-five women were randomized to Burch colposuspension or autologous fascial sling as part of the multicenter Stress Incontinence Surgical Treatment Efficacy Trial. Preoperatively and 24 months after surgery, participants underwent standardized urodynamic testing that included noninvasive uroflowmetry, cystometrogram, and pressure flow studies. Changes in urodynamic parameters were correlated to a successful outcome, defined a priori as (1) negative pad test; (2) no urinary incontinence on 3-day diary; (3) negative cough and Valsalva stress test; (4) no self-reported SUI symptoms on the Medical, Epidemiologic and Social Aspects of Aging Questionnaire; and (5) no re-treatment for SUI.
Results: Subjects who met criteria for surgical success showed a greater relative increase in mean Pdet@Qmax (baseline vs 24 months) than women who were considered surgical failures (P = .008). Although a trend suggested an association between greater increases in bladder outlet obstruction index and outcome success, this was not statistically significant. Other urodynamic variables, such as maximum uroflow, bladder compliance, and the presence of preoperative or de novo detrusor overactivity did not differ with respect to outcome status.
Conclusions: Successful outcomes in both surgical groups (Burch and sling) were associated with higher voiding pressures relative to preoperative baseline values. However, concomitant changes in other urodynamic voiding parameters were not significantly associated with outcome.
Copyright © 2011 Elsevier Inc. All rights reserved.
Source: PubMed