EFFECTIVE PARAMETERS OF URODYNAMIC STUDY BEFORE PELVIC ORGAN PROLAPSE SURGERY AND VALIDATION OF CONCOMITANT SURGERY ON URINARY OUTCOMES: RETROSPECTIVE COHORT STUDY
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Objective To evaluate effective parameters of preoperative urodynamic study (UDS) before performing surgery for pelvic organ prolapse (POP)and to validate effectiveness of concomitant surgery on urinary outcomes. Methods This was a retrospective cohort study of 308 patients who had UDS before POP surgery from January 2006 through December 2010at Yonsei University Severance Hospital, Seoul, Korea. The patients who were diagnosed with stress urinary incontinence (SUI) by positive result of UDS (group 1) had a concomitant sling operation with POP surgery. And the patients were not diagnosed with SUI by negative result of UDS (group 2) did not. Results The prevalence rate of de novo SUI in group 2 (3.1%, n = 4) higher than group 1 (1.7%, n = 3), but there was no statistically signifi cant difference between the two groups. We checked 5 parameters of UDS (valsalva leak point pressure, maximal urethral closing pressure [MUCP], maximal fl ow rates, detrusor pressure at maximal fl ow [PdetMax], maximal cystometric capacity confi dence). PdetMax and MUCP was statistically signifi cant parameter in postoperative de novo SUI (odds ratio [OR], 1.020; 95% confi dence intervals [CI],1.001-1.038) and postoperative de novo urgency urinary incontinence (UUI; OR 0.969; 95% CI, 0.942-0.996). Conclusion This study suggests that results of preoperative UDS and concomitant surgery can be associated with prevalence rate of postoperative de novo SUI. Focused on prevalence of postoperative urinary complications, concomitant surgery was better than only prolapse surgery. PdetMax in SUI and MUCP in UUI were statistically signifi cant parameters of UDS related on urinary outcome.
Abstract
Objective To evaluate effective parameters of preoperative urodynamic study (UDS) before performing surgery for pelvic organ prolapse (POP)and to validate effectiveness of concomitant surgery on urinary outcomes. Methods This was a retrospective cohort study of 308 patients who had UDS before POP surgery from January 2006 through December 2010at Yonsei University Severance Hospital, Seoul, Korea. The patients who were diagnosed with stress urinary incontinence (SUI) by positive result of UDS (group 1) had a concomitant sling operation with POP surgery. And the patients were not diagnosed with SUI by negative result of UDS (group 2) did not. Results The prevalence rate of de novo SUI in group 2 (3.1%, n = 4) higher than group 1 (1.7%, n = 3), but there was no statistically signifi cant difference between the two groups. We checked 5 parameters of UDS (valsalva leak point pressure, maximal urethral closing pressure [MUCP], maximal fl ow rates, detrusor pressure at maximal fl ow [PdetMax], maximal cystometric capacity confi dence). PdetMax and MUCP was statistically signifi cant parameter in postoperative de novo SUI (odds ratio [OR], 1.020; 95% confi dence intervals [CI],1.001-1.038) and postoperative de novo urgency urinary incontinence (UUI; OR 0.969; 95% CI, 0.942-0.996). Conclusion This study suggests that results of preoperative UDS and concomitant surgery can be associated with prevalence rate of postoperative de novo SUI. Focused on prevalence of postoperative urinary complications, concomitant surgery was better than only prolapse surgery. PdetMax in SUI and MUCP in UUI were statistically signifi cant parameters of UDS related on urinary outcome.
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