AN ANALYSIS OF 10,500 MID URETHRALSLINGS (MUS) AND THE IMPACT OF PRE-OPERATIVE URODYNAMIC STUDIES
F. BACH, P. TOOZS-HOBSON;
Birmingham Women's Hosp., Birmingham, United Kingdom.
Introduction: The UK NICEGuidance states urodynamic studies (UDS) are not mandated prior toMUS for symptoms of pure stress urinary incontinence (SUI). However,we are taught that “The bladder is an unreliable witness”;multiple papers have shown symptoms may not always marry up withurodynamic diagnosis. The concern of detrusor overactivity (DO)leading to symptoms of SUI and the subsequent worsening of symptomsof overactivity following MUS means that, anecdotally, manyclinicians still routinely perform UDS prior to an MUS.
Objective:To evaluate the effect urodynamic diagnosis has on Patient GlobalImpression of Improvement of Incontinence (PGI-I), change in SUIsymptoms and change in OAB symptoms following MUS.
Methods:With permission, 10,681 records from the BSUG database were analysedusing excel and Chi2.
Results: 91.7% patientswith urodynamic stress incontinence (USI) on UDS reported being“better” (‘very much’ or ‘much better’) on PGI-I comparedto 86% with some element of DO on UDS (graph 1) (p<0.05).
Greaternumbers of patients reported their SUI cured if there was no elementof DO in the UDS. The greatest percentage of patients who found theirSUI was “worse” was those with DO on UDS (graph 2).
The changein symptoms of OAB is more complex (graph 3). There is the perceptionof cure or improvement of DO in many cases (25-55%) but the groupwith pure DO on UDS has the fewest reports of cure but also thehighest percentage of patients reporting worsening of OAB. Voidingdifficulties are associated with worse outcomes. It is unclear whypatients received MUS without USI on UDS.
Conclusions:Urodynamics is helpful prior to MUS as pre-operative UDO and voidingdifficulties are associated with poorer outcomes. The database givesno information on prior intervention for DO or indeed what thelong-term outcomes for these patients were. Both of these questionsmay be answered if the ideals of ICHOM were implemented and a“disease based database” was adopted. It will be interesting tosee prospectively how UDS change management as planned forINVESTIGATE.
Ultimately, it is important to counsel women aboutindividualised success rates dependent on patient characteristicsfollowing insertion of a MUS.