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

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1257-1262
Number of pages6
JournalUrology
Volume78
Issue number6
DOIs
StatePublished - Dec 2011

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Stress Urinary Incontinence
Urodynamics
Urinary Bladder Neck Obstruction
Pressure
Urinary Incontinence
Exercise Test
Cough
Compliance
Urinary Bladder

ASJC Scopus subject areas

  • Urology

Cite this

Urodynamic changes associated with successful stress urinary incontinence surgery : Is a little tension a good thing? / Kraus, Stephen R; Lemack, Gary E.; Sirls, Larry T.; Chai, Toby C.; Brubaker, Linda; Albo, Michael; Leng, Wendy W.; Lloyd, L. Keith; Norton, Peggy; Litman, Heather J.

In: Urology, Vol. 78, No. 6, 12.2011, p. 1257-1262.

Research output: Contribution to journalArticle

Kraus, SR, Lemack, GE, Sirls, LT, Chai, TC, Brubaker, L, Albo, M, Leng, WW, Lloyd, LK, Norton, P & Litman, HJ 2011, 'Urodynamic changes associated with successful stress urinary incontinence surgery: Is a little tension a good thing?', Urology, vol. 78, no. 6, pp. 1257-1262. https://doi.org/10.1016/j.urology.2011.07.1413
Kraus, Stephen R ; Lemack, Gary E. ; Sirls, Larry T. ; Chai, Toby C. ; Brubaker, Linda ; Albo, Michael ; Leng, Wendy W. ; Lloyd, L. Keith ; Norton, Peggy ; Litman, Heather J. / Urodynamic changes associated with successful stress urinary incontinence surgery : Is a little tension a good thing?. In: Urology. 2011 ; Vol. 78, No. 6. pp. 1257-1262.
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AU - Chai, Toby C.

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AU - Albo, Michael

AU - Leng, Wendy W.

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N2 - 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.

AB - 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.

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