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Urodynamic Prolapse Assessment: When and Why

  • Andrea Braga
  • Martina Milanesi
  • Giulio Del PopoloEmail author
Chapter
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)

Abstract

The role of urodynamic studies (UDS) before prolapse surgery is controversial and remains one of the most debated issues in urogynaecology [1]. POP and lower urinary tract symptoms (LUTS) often coexist as they may have a similar underlying pathophysiology. Up to 96% of women with POP report LUTS with mixed urinary incontinence predominating [1]. Nevertheless, it has not been possible to reach a universal consensus on the role of UDS before prolapse surgery, especially in women with concomitant symptomatic or occult stress urinary incontinence (SUI). The implementation of powerful and sophisticated instruments, such as artificial neural networks or multiple linear regression, does not permit an accurate diagnosis of the lower urinary tract dysfunction based on symptoms and pelvic examination findings [2]. The data on the use of UDS in patients with uncomplicated and pure SUI are conflicting and heterogeneous [3, 4]. Very few data exist on the role of UDS in the preoperative evaluation of women with POP. The latest recommendations of the International Consultation on Incontinence for the management of POP suggest only selective use of UDS when the results would alter the planned treatment [5]. It is clear that UDS could add some information in women undergoing pelvic organ prolapse surgery and could facilitate counselling of patients. However, there is no evidence that the outcome of surgery is altered by prior UDS. The question is whether how UDS can really change the choice of surgery and its outcome in women with POP (Fig. 5.1).

References

  1. 1.
    Serati M, Giarenis I, Meschia M, Cardozo L. Role of urodynamics before prolapse surgery. Int Urogynecol J. 2015;26:165–8.CrossRefGoogle Scholar
  2. 2.
    Serati M, Salvatore S, Siesto G, Cattoni E, Braga A, Sorice P, et al. Urinary symptoms and urodynamic findings in women with pelvic organ prolapse: is there a correlation? Results of an artificial neural network analysis. Eur Urol. 2011;60:253–60.CrossRefGoogle Scholar
  3. 3.
    Weber AM, Taylor RJ, Wei JT, Lemack G, Piedmonte MR, Walters MD. The cost-effectiveness of preoperative testing (basic office assessment vs. urodynamics) for stress urinary incontinence in women. BJU Int. 2002;89:356–63.CrossRefGoogle Scholar
  4. 4.
    Digesu GA, Hendricken C, Fernando R, Khullar V. Do women with pure stress urinary incontinence need urodynamics? Rology. 2009;74:278–81.Google Scholar
  5. 5.
    Abrams P, Andersson KE, Apostolidis A, et al. Recommendation of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence: 6th International Consultation on Incontinence. Tokyo: ICUD-ICS; 2016. p. 2549–97.Google Scholar
  6. 6.
    Weber AM, Walters MD. Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol. 2000;183:1338–47.CrossRefGoogle Scholar
  7. 7.
    van der Ploeg J, van der Steen A, Oude Rengerink K, van der Vaart C, Roovers J. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121:537–47.CrossRefGoogle Scholar
  8. 8.
    Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.CrossRefGoogle Scholar
  9. 9.
    Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, et al. Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol. 2008;112:49–55.CrossRefGoogle Scholar
  10. 10.
    Srikrishna S, Robinson D, Cardozo L. Ringing the changes in evaluation of urogenital prolapse. Int Urogynecol J. 2011;22:171–5.CrossRefGoogle Scholar
  11. 11.
    Christian Winters J, Dmochowski RR, Goldman HB, Anthony Herndon CD, Kobashi KC, Kraus SR, Lemack GE, Nitti VW, Rovner ES, Wein AJ. Urodynamic studies in adults: AUA/SUFU Guideline. J Urol. 2012.  https://doi.org/10.1016/j.juro.2012.09.081.
  12. 12.
    Roovers JP, Oelke M. Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review. Int Urogynecol J. 2007;18:455–60.CrossRefGoogle Scholar
  13. 13.
    Schierlitz L, Dwyer PL, Rosamilia A, et al. Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial. Int Urogynecol J. 2014;25:33–40.CrossRefGoogle Scholar
  14. 14.
    Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A, et al. Three year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol. 2012;119:321–7.CrossRefGoogle Scholar
  15. 15.
    Salvatore S, Serati M, Ghezzi F, Uccella S, Cromi A, Bolis P. Efficacy of tolterodine in women with detrusor overactivity and anterior vaginal wall prolapse: is it the same? BJOG. 2007;114:1436–8.CrossRefGoogle Scholar
  16. 16.
    Araki I, Haneda Y, Mikami Y, Takeda M. Incontinence and detrusor dysfunction associated with pelvic organ prolapse: clinical value of preoperative urodynamic evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1301–6.CrossRefGoogle Scholar
  17. 17.
    Nguyen JK, Bahatia NN. Resolution of motor urge incontinence after surgical repair of pelvic organ prolapse. J Urol. 2001;166:2263–6.CrossRefGoogle Scholar
  18. 18.
    Fletcher SG, Haverkorn RM, Yan J, Lee JJ, Zimmern PE, Lemack GE. Demographic and urodynamic factors associated with persistent OAB after anterior compartment prolapse repair. Neurourol Urodyn. 2010;29:1414–8.CrossRefGoogle Scholar
  19. 19.
    Lee DM, Ryu YW, Lee YT, Ahn SH, Han JH, Yum SH. A predictive factor in overactive bladder symptoms improvement after combined anterior vaginal wall prolapse repair: a pilot study. Korean J Urol. 2012;53:405–9.CrossRefGoogle Scholar
  20. 20.
    Abdullah B, Nomura J, Moriyama S, Huang T, Tokiwa S, Togo M. Clinical and urodynamic assessment in patients with pelvic organ prolapse before and after laparoscopic sacrocolpopexy. Int Urogynecol J. 2017;28(10):543–1549. [Epub ahead of print].CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andrea Braga
    • 1
  • Martina Milanesi
    • 2
  • Giulio Del Popolo
    • 3
    Email author
  1. 1.Department of Obstetrics and GynecologyEOC—Beata Vergine HospitalMendrisioSwitzerland
  2. 2.Department of UrologyCareggi University HospitalFlorenceItaly
  3. 3.Department of Neuro-UrologyCareggi University HospitalFlorenceItaly

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