REVISITING EARLY LEAK DURING URODYNAMICS: IS IT PREDICTIVE OF FAILURE IN THE SURGICAL MANAGEMENT OF STRESS URINARY INCONTINENCE?
MARTIN1, M. JEAN-MICHEL 2, L. M. ESPAILLAT-RIJO 3, H. DEVAKUMAR 4, J. S. SCHACHAR 4, E. A. HURTADO 4, G. DAVILA 4;
1Gynecology, Cleveland Clinic Florida, Weston, FL, 2Bronx-Lebanon Hosp. Ctr./ Albert Einstein Col, Bronx, NY, 3Lehigh Valley Hlth.Network, Bethlehem, PA, 4Cleveland Clinic Florida, Weston, FL.
Introduction: Stress urinary incontinence (SUI) is a common genitourinary condition affecting anywhere from 5-61% of the adult female population. (1) In the United States, an analysis from 2007-20011 showed that there is a life time risk of surgery for stress incontinence of about 13.6%. (2) Furthermore, this number is expected to rise substantially in accordance with population growth projections.
At our institution, urodynamics (UDS) are an integral part of patient evaluation. It has been shown that patients with intrinsic sphincter deficiency (ISD) found on UDS are more likely to fail surgical intervention with a transobturator mid-urethral sling than non-ISD patients. (3) However, a previous review in 2009 failed to show the predictability of early leaking (less than or equal to 150 ml) on UDS in regard to surgical success. Therefore, we revisited the question if patients with stress urinary incontinence who leak early represent a more severe disease state causing increased failures after surgical intervention?
Objective: To determine whether patients with stress urinary incontinence, who leak with cough and/or valsalva early during cystometrogram, are more likely to fail surgical correction.
Methods: This is a retrospective review performed on patients with surgical management of stress urinary incontinence from 2010-2016. Patients were selected from a single site via an urogynecologic database. During pre-operative UDS patients were asked to cough and/or valsalva every 50 ml during bladder filling and any leakage of urine was documented. Post-operatively, they were grouped into successes and failures. A successful outcome was defined as a patient report of less than or equal to 0-1 daily leakage of urine, and a subjective report of cured, greatly improved, or somewhat improved. Patients were also required to have a negative supine stress test on exam. If any of these parameters were not met, they were considered failures. Demographic data was collected for each group as well as urodynamic parameters including: volume at first leakage (less than or equal to 150 ml), leak point pressures 60 mmHg or less, and maximum urethral closure pressure (MUCP) 20 mmHg or less. Continuous data was analyzed with a t-test and categorical data with a Fisher exact test. A significance criterion of 0.05 will be assumed for all analyses.
Results: A total of 144 patients were selected from the single site urogynecologic database with a mean follow-up of 52 weeks (min 45, max 60). Of these 144 patients, there were 133 successful urinary incontinence procedures compared to 12 failures defined by the above criteria. Demographic data was similar across the two groups: mean parity was 2, incidence of diabetes (p=0.635) and neurologic disease (p=0.329), and BMI (p=0.888). When comparing urodynamic parameters, there was no difference between the successes and the failures: Volume at first leak (p=0.384), leak point pressures at 150 ml (p=1.00), and MUCP (p=1.00). Finally, an analysis of the type of anti-incontinence procedure in each group was done, and found no difference amongst the two groups.
Conclusions: We did not find that early leaking of urine on UDS was predictive of failure after an anti-incontinence surgery.
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