Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women

• Published in: The Journal of urology Vol. 190; no. 2; p. 598
• Main Authors: Aponte, Margarita M, Shah, Sagar R, Hickling, Duane, Brucker, Benjamin M, Rosenblum, Nirit, Nitti, Victor W
• Format: Journal Article
• Language: English
• Published: United States 01-08-2013
• Subjects: Adult; Aged; Aged, 80 and over; Analysis of Variance; Female; Humans; Middle Aged; Postoperative Complications - physiopathology; Postoperative Complications - therapy; Retrospective Studies; Treatment Outcome; Urinary Incontinence, Stress - surgery; Urinary Retention - physiopathology; Urinary Retention - surgery; Urodynamics; anti-incontinence surgery; post-void residual urine volume; stress urinary incontinence; UDS; SUI; VUDS; detrusor overactivity; urinary bladder; videourodynamics; MMK; urodynamics; AIS; DO; PVS; PVR; Marshall-Marchetti-Krantz; urinary bladder outlet obstruction; postoperative complications; pubovaginal sling; female
• ISSN: 1527-3792
• DOI: 10.1016/j.juro.2013.03.113

We determined the usefulness of urodynamics in patients with obstruction secondary to anti-incontinence surgery.
We retrospectively reviewed the records of all procedures performed from January 2001 to June 2011 to relieve obstruction due to anti-incontinence surgery. Patients were excluded from study if they underwent prior procedures to relieve obstruction, followup data were missing or a neurological disorder was present. Patients were grouped into categories before intervention, including urodynamics diagnostic of obstruction vs nondiagnostic urodynamics vs no urodynamics testing. We also separated patients with predominantly storage symptoms and those with incomplete emptying.
A total of 71 women were included in analysis. Of 54 women who presented with increased post-void residual urine volume 33 (61%) were diagnosed with obstruction on urodynamics, urodynamics was not diagnostic in 4 (7.4%) and 17 (32%) did not undergo urodynamics preoperatively. All 18 patients with predominantly storage symptoms underwent urodynamics. In patients with incomplete emptying there was no difference between the groups in storage or voiding symptom improvement, overall cure or success according to whether diagnostic urodynamics were or were not done. Of patients with storage symptoms who underwent urodynamics those without evidence of detrusor overactivity had significantly greater storage symptom improvement than those with detrusor overactivity (85.7% vs 53.8%, p = 0.02).
When voiding symptoms or urinary retention is the primary indication for intervention after anti-incontinence surgery, urodynamic findings are not predictive of outcomes after intervention to relieve obstruction. If storage symptoms are the main indication for intervention, urodynamics may be valuable for patient counseling.