Croghan Stefanie M, Costigan Grainne, O'Dwyer Niall, MacCraith Eoin, Lennon Gerry
Department of Urology, St. Vincent's University Hospital, Dublin, Ireland.
Independent Statistician.
Cent European J Urol. 2019;72(4):384-392. doi: 10.5173/ceju.2019.1967. Epub 2019 Sep 26.
Some controversy exists regarding necessity for urodynamic evaluation prior to surgical management of stress urinary incontinence (SUI). We aimed to interrogate the role of pre and post-operative urodynamic studies versus clinical assessment in predicting long-term patient reported outcomes of transobturator tape (TOT) placement.
A 100 patient cohort of women post TOT insertion for stress/mixed urinary incontinence 2005-2010, under a single surgeon, was identified. Results of pre and post-operative clinical assessment and urodynamic studies were retrospectively evaluated. Long-term patient reported outcome measures (PROMs) were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires. The role of urodynamic studies in predicting postoperative voiding dysfunction, and long-term procedure outcomes was analysed. Statistical correlations were performed using SPSS.
Questionnaire response rate was 76/100 (76%) at mean follow-up 9.4 years (7.25-12.75). Mean ICIQ score was 6.32 (1-20). No significant correlations between preoperative pDet QMax and postoperative uroflow/duration of intermittent self catheterisation (ISC), or between preoperative leak-point pressures and outcome were observed. Postoperative urodynamic tests did not reliably predict long-term success in SUI cure. Preoperative clinical urgency was a more reliable predictor of long-term clinical urgency than urodynamic detrusor overactivity. Whilst patients with mixed urinary incontinence at long-term follow-up tended to have the highest (worst) overall ICIQ-SF and ICIQ quality of life score, no studied variables on preoperative CMG were significantly correlated with long-term PROMs.
Whilst urodynamic studies provide important baseline bladder function data, prior to mid-urethral sling placement, this study finds no specific value of either pre or postoperative urodynamics in predicting long-term patient reported outcomes of transobturator tape placement.
对于压力性尿失禁（SUI）手术治疗前进行尿动力学评估的必要性存在一些争议。我们旨在探讨术前和术后尿动力学研究与临床评估在预测经闭孔尿道中段吊带术（TOT）置入患者长期报告结局中的作用。
确定了一组100例在2005年至2010年间由单一外科医生为压力性/混合性尿失禁行TOT置入术的女性患者。对术前和术后临床评估及尿动力学研究结果进行回顾性评估。使用国际尿失禁咨询问卷（ICIQ）简表、患者总体严重程度印象（PGI-S）和患者总体改善印象（PGI-I）问卷评估患者长期报告结局指标（PROMs）。分析尿动力学研究在预测术后排尿功能障碍及长期手术结局中的作用。使用SPSS进行统计相关性分析。
平均随访9.4年（7.25 - 12.75年）时，问卷回复率为76/100（76%）。ICIQ平均评分为6.32（1 - 20）。未观察到术前最大排尿期逼尿肌压力（pDet QMax）与术后尿流率/间歇性自我导尿（ISC）持续时间之间，或术前漏尿点压力与结局之间存在显著相关性。术后尿动力学检查不能可靠地预测SUI治愈的长期成功率。术前临床尿急比尿动力学逼尿肌过度活动更能可靠地预测长期临床尿急。虽然长期随访中混合性尿失禁患者往往具有最高（最差）的总体ICIQ-SF和ICIQ生活质量评分，但术前膀胱测压图（CMG）的研究变量与长期PROMs均无显著相关性。
虽然尿动力学研究在尿道中段吊带置入术前可提供重要的膀胱功能基线数据，但本研究发现术前或术后尿动力学在预测经闭孔尿道中段吊带术置入患者长期报告结局方面均无特定价值。
