Urodynamic Prolapse Assessment: When and Why
The role of urodynamic studies (UDS) before prolapse surgery is controversial and remains one of the most debated issues in urogynaecology . 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 . 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 . 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 . 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).
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