Although preoperative urodynamic studies frequently change clinical diagnoses, they rarely lead to changes in the surgical or global treatment plans for women with stress urinary incontinence (UI), according to research published in The Journal of Urology (2013:189:204-209).
To examine the effect of preoperative urodynamic studies on global treatment plans, Larry T. Sirls, MD, of the William Beaumont Hospital in Royal Oak, Mich., and colleagues conducted a secondary analysis of data from a randomized trial involving 294 women with uncomplicated stress UI who were randomized to preoperative urodynamic studies.
In 56.8% of women, urodynamic studies changed the office evaluation diagnoses, significantly reducing the diagnoses of overactive bladder-wet, overactive bladder-dry, and intrinsic sphincter deficiency, and significantly increasing the diagnosis of voiding dysfunction, according to the researchers. After urodynamic studies, surgery was cancelled for 1.4% of women, the incontinence procedure was changed for 4.4%, and plans were made to modify the mid urethral sling tension in 6.8%. Non-operative treatment plans were changed for 14%. Treatment plan changes were not linked to treatment success but did correlate with significantly increased postoperative treatment for urge UI.
“Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans,” the investigators wrote. “Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.”