Department of Gynecology, Jeanne de Flandre University Hospital, Lille, France.
1(st) Department of Obstetrics and Gynecology Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece.
Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:176-181. doi: 10.1016/j.ejogrb.2024.04.024. Epub 2024 Apr 21.
Stress urinary incontinence (SUI) is defined as a condition characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure which may decrease quality of life with a significant economic impact on health systems, necessitating the implementation of cost-effective management plans. Urodynamics (UDS) has been considered during the last decades as the gold standard for assessment of lower urinary tract symptoms (LUTS) due to their high reproducibility. At the same time, concerns about the systematic use of UDS before SUI surgery were raised due to a limited evidenced base to recommend their routine use. In uncomplicated female patients with SUI, UDS can offer further insights into LUTS, potentially assisting the physician in determining the appropriate therapeutic approach. However, it has not been shown that preoperative UDS can directly impact the surgical outcome for continence. Indeed, evidence supports the conclusion that pre-operative UDS in women with uncomplicated, clinically demonstrable, SUI does not improve the outcome of surgery for SUI. Nevertheless, asymptomatic detrusor overactivity (DO) identified by urodynamic testing or pre-existing voiding dysfunction are associated with an increased occurrence of postoperative overactive bladder (OAB) and voiding dysfunction, respectively. The EUGA Working Group concluded that the evidence does not support the systematic preoperative use of UDS for uncomplicated cases. However, in cases where mixed symptoms, voiding dysfunction, previous surgery, or concomitant prolapse are present, preoperative UDS are advised as they can be beneficial in anticipating postoperative outcomes. This aids in conducting comprehensive and thorough preoperative counseling. The Group recommend performing preoperative UDS considering the patient's specific clinical situation and the surgeon's judgment, with consideration given to the potential benefits, risks, and impact on treatment decisions and patient outcomes.
压力性尿失禁（SUI）是一种在增加腹内压的活动中出现不自主漏尿的病症，可能会降低生活质量，并对医疗系统造成重大的经济影响，因此需要实施具有成本效益的管理计划。在过去几十年中，尿动力学（UDS）一直被认为是评估下尿路症状（LUTS）的金标准，因为其具有高度的可重复性。与此同时，由于缺乏推荐常规使用 UDS 的循证依据，人们对在 SUI 手术前系统使用 UDS 提出了担忧。在没有合并症的女性 SUI 患者中，UDS 可以进一步深入了解 LUTS，可能有助于医生确定适当的治疗方法。然而，术前 UDS 并不能直接影响手术的治疗效果。事实上，有证据支持这样的结论，即对于没有合并症、临床可证实的 SUI 患者，术前 UDS 并不能改善 SUI 手术的效果。然而，尿动力学检查发现的无症状逼尿肌过度活动（DO）或预先存在的排尿功能障碍分别与术后膀胱过度活动症（OAB）和排尿功能障碍的发生率增加有关。EUGA 工作组得出结论，目前的证据并不支持系统地在没有合并症的情况下术前使用 UDS。然而，在存在混合症状、排尿功能障碍、既往手术或同时存在脱垂的情况下，建议进行术前 UDS，因为它可以帮助预测术后结果。这有助于进行全面和彻底的术前咨询。工作组建议根据患者的具体临床情况和外科医生的判断来进行术前 UDS，同时考虑潜在的益处、风险以及对治疗决策和患者结果的影响。
