Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA.
Department of Urology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles, Los Angeles, CA, USA.
Int Urogynecol J. 2020 Aug;31(8):1663-1668. doi: 10.1007/s00192-019-04084-8. Epub 2019 Aug 27.
Preoperative urodynamic studies (UDS) are frequently performed before pelvic organ prolapse (POP) surgery to assess urethral and bladder function. The primary goal of this study is to examine how preoperative UDS are utilized and what value these studies have in patient treatment and/or counseling.
We retrospectively reviewed patients who underwent prolapse surgery and had preoperative UDS between June 2010 and February 2015. Indications for UDS were classified into four categories: (1) occult stress urinary incontinence only, (2) overactive bladder symptoms, (3) mixed or insensible urinary incontinence, and (4) voiding symptoms and/or elevated post-void residual. We identified changes in management or counseling that were directly attributable to UDS results prior to surgery.
Three hundred ninety-two patients underwent urodynamic testing for indications 2-4 above, and 316 met the inclusion criteria. Fifty-seven percent (180/316) had OAB symptoms (34.4% wet, 65.6% dry), 40.2% (127/316) had mixed incontinence, and 17.1% (54/316) had voiding symptoms and/or elevated PVR. A total of 3.5% (11/316) patients had alteration in their management or counseling based on the results of the UDS; 29.4% (50/170) of the women evaluated for occult SUI alone or with other symptoms demonstrated it and 41 underwent sling placement.
UDS did not have a significant impact on preoperative management or counseling in POP surgery if demonstration of occult SUI was not the indication for preoperative study in women committed to POP surgery. Major alterations in treatment were rare and occurred mostly in women with stress incontinence that also had concomitant voiding symptoms and/or elevated PVR.
术前尿动力学研究（UDS）常用于盆腔器官脱垂（POP）手术前，以评估尿道和膀胱功能。本研究的主要目的是研究术前 UDS 的使用情况以及这些研究在患者治疗和/或咨询中的价值。
我们回顾性分析了 2010 年 6 月至 2015 年 2 月间接受脱垂手术且术前进行 UDS 的患者。UDS 的适应证分为四类：（1）隐匿性压力性尿失禁，（2）膀胱过度活动症（OAB）症状，（3）混合性或感觉性尿失禁，（4）排尿症状和/或残余尿量升高。我们确定了术前 UDS 结果直接导致的治疗或咨询的变化。
392 例患者因上述适应证 2-4 行尿动力学检查，其中 316 例符合纳入标准。57%（180/316）有 OAB 症状（34.4% 为湿型，65.6% 为干型），40.2%（127/316）为混合性尿失禁，17.1%（54/316）有排尿症状和/或残余尿量升高。共有 3.5%（11/316）的患者根据 UDS 结果改变了他们的管理或咨询；单纯隐匿性 SUI 或伴有其他症状的女性中，有 29.4%（50/170）证实存在该情况，其中 41 例行吊带术。
如果术前研究的适应证不是隐匿性 SUI，那么 UDS 对 POP 手术患者的术前管理或咨询没有显著影响。治疗的重大改变很少发生，主要发生在同时伴有排尿症状和/或残余尿量升高的压力性尿失禁患者中。
