urodynamics Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , Summary
Rev Bras Ginecol Obstet. 2022;44(7):654-659
, , , Urodynamic studies (UDSs) are a set of tests that assess the storage and emptying of urine, and they are widely used by gynecologists and urologists in the management of urinary incontinence (UI), despite the discussion about its indications. The objectives of the present study were to verify whether UDSs are routinely used in the conservative and surgical approaches to female UI, their other clinical indications, and to compare the responses of Brazilian gynecologists and urologists.
The present is an opinion survey applied from August 2020 to January 2021 through a semistructured questionnaire about the clinical practice sent by e-mail to all participants. The responses were compared through statistical analyses.
Of the 329 participants, 238 were gynecologists (72.3%) and 91, urologists (27.7%). Most gynecologists (73.5%) and urologists (86.6%) do not request UDSs before the conservative treatment of UI; but UDSs are indicated in the preoperative period of anti-incontinence surgeries. Most participants request UDSs in the initial approach to overactive bladder (gynecologists: 88.2%; urologists: 96.7%), and the urologist has greater chance to request this study (odds ratio [OR] = 3.9). For most participants, it is necessary to request uroculture before the UDSs.
Most Brazilian gynecologists and urologists who participated in the present study do not request UDSs before the conservative treatment of UI, according to national and internacional guidelines, and often request it before the surgical treatment for female UI. The indication of this exam in the initial approach of idiopathic overactive bladder should be reviewed by the participants.
Summary
Rev Bras Ginecol Obstet. 2022;44(7):654-659
, , , Urodynamic studies (UDSs) are a set of tests that assess the storage and emptying of urine, and they are widely used by gynecologists and urologists in the management of urinary incontinence (UI), despite the discussion about its indications. The objectives of the present study were to verify whether UDSs are routinely used in the conservative and surgical approaches to female UI, their other clinical indications, and to compare the responses of Brazilian gynecologists and urologists.
The present is an opinion survey applied from August 2020 to January 2021 through a semistructured questionnaire about the clinical practice sent by e-mail to all participants. The responses were compared through statistical analyses.
Of the 329 participants, 238 were gynecologists (72.3%) and 91, urologists (27.7%). Most gynecologists (73.5%) and urologists (86.6%) do not request UDSs before the conservative treatment of UI; but UDSs are indicated in the preoperative period of anti-incontinence surgeries. Most participants request UDSs in the initial approach to overactive bladder (gynecologists: 88.2%; urologists: 96.7%), and the urologist has greater chance to request this study (odds ratio [OR] = 3.9). For most participants, it is necessary to request uroculture before the UDSs.
Most Brazilian gynecologists and urologists who participated in the present study do not request UDSs before the conservative treatment of UI, according to national and internacional guidelines, and often request it before the surgical treatment for female UI. The indication of this exam in the initial approach of idiopathic overactive bladder should be reviewed by the participants.
Summary
Rev Bras Ginecol Obstet. 2013;35(1):16-20
DOI 10.1590/S0100-72032013000100004
PURPOSE: To evaluate the correlation between the International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) and Urodynamic evaluation (UE) in women with urinary incontinence (UI). METHODS: Clinical data, UE and ICIQ-UI/SF scores for 358 patients from private health service were analyzed retrospectively . The correlation between ICIQ-UI/SF and urodynamic parameters was determined by Spearman's test. A ROC curve with the sensitivity and specificity of the ICIQ-UI/SF scores was utilized to establish the value of the questionnaire that would predict an altered urodynamic parameter. The c² test or Fisher's exact test was used to calculate the p-value. The level of significance was 5% and the software used was SAS 9.2. RESULTS: Sixty-seven point three percent of the patients presented Stress UI (SUI) according to the UE (urodynamic SUI); those with SUI and Detrusor overactivity (DO) at UE represented 16.2% of the women (SUI+DO), and those with only DO at UE (DO) represented 7.3% of the women. Patients with normal UE represented 9.2% of the women. There was a significant association between ICIQ-UI/SF scores ³14 and patients with urodynamic SUI, with or without DO. Patients with Valsava Leak Point Pressure (VLPP)£90 cmH2O presented ICIQ-UI/SF³15. Spearman's test showed a weak inverse correlation between ICIQ-UI/SF score and VLPP, although it did not show any correlation with maximum cystometric capacity or with bladder volume on first desire to void. CONCLUSION: There was an association between ICIQ-UI/SF score and patients with SUI, with or without DO, but no association between the score and patients with DO alone. The lower the VLPP value, the higher the ICIQ-UI/SF score. The ICIQ-UI/SF was not able to distinguish the different types of UI in the studied population
Summary
Rev Bras Ginecol Obstet. 2013;35(1):16-20
DOI 10.1590/S0100-72032013000100004
PURPOSE: To evaluate the correlation between the International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) and Urodynamic evaluation (UE) in women with urinary incontinence (UI). METHODS: Clinical data, UE and ICIQ-UI/SF scores for 358 patients from private health service were analyzed retrospectively . The correlation between ICIQ-UI/SF and urodynamic parameters was determined by Spearman's test. A ROC curve with the sensitivity and specificity of the ICIQ-UI/SF scores was utilized to establish the value of the questionnaire that would predict an altered urodynamic parameter. The c² test or Fisher's exact test was used to calculate the p-value. The level of significance was 5% and the software used was SAS 9.2. RESULTS: Sixty-seven point three percent of the patients presented Stress UI (SUI) according to the UE (urodynamic SUI); those with SUI and Detrusor overactivity (DO) at UE represented 16.2% of the women (SUI+DO), and those with only DO at UE (DO) represented 7.3% of the women. Patients with normal UE represented 9.2% of the women. There was a significant association between ICIQ-UI/SF scores ³14 and patients with urodynamic SUI, with or without DO. Patients with Valsava Leak Point Pressure (VLPP)£90 cmH2O presented ICIQ-UI/SF³15. Spearman's test showed a weak inverse correlation between ICIQ-UI/SF score and VLPP, although it did not show any correlation with maximum cystometric capacity or with bladder volume on first desire to void. CONCLUSION: There was an association between ICIQ-UI/SF score and patients with SUI, with or without DO, but no association between the score and patients with DO alone. The lower the VLPP value, the higher the ICIQ-UI/SF score. The ICIQ-UI/SF was not able to distinguish the different types of UI in the studied population
Summary
Rev Bras Ginecol Obstet. 2011;33(12):414-420
DOI 10.1590/S0100-72032011001200007
PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS: Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients. CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).
Summary
Rev Bras Ginecol Obstet. 2011;33(12):414-420
DOI 10.1590/S0100-72032011001200007
PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS: Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients. CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).
Summary
Rev Bras Ginecol Obstet. 2007;29(2):91-95
DOI 10.1590/S0100-72032007000200006
PURPOSE: compare the outcomes verified during urodynamic investigation realized in two different positions related to urinary leak point pressure under stress and to discuss its clinical relevance. METHODS: sixty-four patients with stress urinary incontinency (SUI) aged 25-80 years old, attended, during June 2003 to September 2005 were included in this study. Patients were initially submitted to urodynamic investigation in accordance with International Continence Society (ICS) techniques in orthostatic position and just after were evaluated in seating position. RESULTS: statistical significance was obtained after evaluation of Vasalva leak point pressure (VLPP) obtained in two positions (99,8 ± 33,3 versus 102,9 ± 32,4; respectivamente, posição sentada e em pé, p<0,05). Linear regression test based on frequency analyses was applied with the purpose to verify the patient percentage allocated in confidence interval in terms of Valsalva leak point pressure in seating or orthostatic positions. A rate of 90.6% of compatibility was gotten in these results. When three unities were added to VLPP values after urodynamic investigation in seating position, it was noted that 92.2% of patients was included in this interval. CONCLUSIONS: these findings suggest that the urodynamic investigation can be realized in seating position without diagnostic a therapeutic impairment allowing higher comfort to the patients.
Summary
Rev Bras Ginecol Obstet. 2007;29(2):91-95
DOI 10.1590/S0100-72032007000200006
PURPOSE: compare the outcomes verified during urodynamic investigation realized in two different positions related to urinary leak point pressure under stress and to discuss its clinical relevance. METHODS: sixty-four patients with stress urinary incontinency (SUI) aged 25-80 years old, attended, during June 2003 to September 2005 were included in this study. Patients were initially submitted to urodynamic investigation in accordance with International Continence Society (ICS) techniques in orthostatic position and just after were evaluated in seating position. RESULTS: statistical significance was obtained after evaluation of Vasalva leak point pressure (VLPP) obtained in two positions (99,8 ± 33,3 versus 102,9 ± 32,4; respectivamente, posição sentada e em pé, p<0,05). Linear regression test based on frequency analyses was applied with the purpose to verify the patient percentage allocated in confidence interval in terms of Valsalva leak point pressure in seating or orthostatic positions. A rate of 90.6% of compatibility was gotten in these results. When three unities were added to VLPP values after urodynamic investigation in seating position, it was noted that 92.2% of patients was included in this interval. CONCLUSIONS: these findings suggest that the urodynamic investigation can be realized in seating position without diagnostic a therapeutic impairment allowing higher comfort to the patients.
Summary
Rev Bras Ginecol Obstet. 1999;21(2):77-81
DOI 10.1590/S0100-72031999000200004
Purpose: to evaluate the frequency of urinary disorders and variation of the urodynamic parameters according to the time of post-menopause. Method: two hundred forty-two post-menopausal women with urinary complaints were studied at the Division of Gynecology, Escola Paulista de Medicina, UNIFESP. They were grouped according to the time of post-menopause: group A - up to 4 years; group B - 5 to 9 years and group C - more than 10 years. They were submitted to anamnesis, gynecological examination and urodynamic study. The frequency of urinary alterations and the variation of the urodynamic parameters were analyzed, such as voiding volume; flow time; maximum flow rate, average flow rate; residual urine; vesical capacity at the first desire to void; maximum bladder capacity; maximum urethral closure pressure and functional profile length, with full and empty bladder. The data were statistically analyzed. Results: the most common clinical diagnosis was stress urinary incontinence in the three groups, but the longer the time of post-menopause, the more frequently urinary urgency was observed. Regarding urodynamic diagnosis, 93.6%, 84.6% and 90.7% of the patients of the groups A, B and C, respectively, presented stress urinary incontinence, while 4.8%, 13.5% and 6.2% revealed detrusor instability. There was a decrease in the following urodynamic parameters, according to the time of post-menopause: flow time, maximum flow rate and vesical capacity at the first desire to void, and an increase of the residual urine. Conclusion: in spite of the high incidence of urinary symptoms such as urgency incontinence, stress urinary incontinence was the main urinary problem we have found in post-menopause.
Summary
Rev Bras Ginecol Obstet. 1999;21(2):77-81
DOI 10.1590/S0100-72031999000200004
Purpose: to evaluate the frequency of urinary disorders and variation of the urodynamic parameters according to the time of post-menopause. Method: two hundred forty-two post-menopausal women with urinary complaints were studied at the Division of Gynecology, Escola Paulista de Medicina, UNIFESP. They were grouped according to the time of post-menopause: group A - up to 4 years; group B - 5 to 9 years and group C - more than 10 years. They were submitted to anamnesis, gynecological examination and urodynamic study. The frequency of urinary alterations and the variation of the urodynamic parameters were analyzed, such as voiding volume; flow time; maximum flow rate, average flow rate; residual urine; vesical capacity at the first desire to void; maximum bladder capacity; maximum urethral closure pressure and functional profile length, with full and empty bladder. The data were statistically analyzed. Results: the most common clinical diagnosis was stress urinary incontinence in the three groups, but the longer the time of post-menopause, the more frequently urinary urgency was observed. Regarding urodynamic diagnosis, 93.6%, 84.6% and 90.7% of the patients of the groups A, B and C, respectively, presented stress urinary incontinence, while 4.8%, 13.5% and 6.2% revealed detrusor instability. There was a decrease in the following urodynamic parameters, according to the time of post-menopause: flow time, maximum flow rate and vesical capacity at the first desire to void, and an increase of the residual urine. Conclusion: in spite of the high incidence of urinary symptoms such as urgency incontinence, stress urinary incontinence was the main urinary problem we have found in post-menopause.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):54-62
DOI 10.1590/S0100-72032006000100010
Female lower urinary tract symptoms are nonspecific and a clinical evaluation is required to establish the correct diagnosis. Such evaluation should consist of a structured micturition history or questionnaire, physical examination, micturition diary, pad test, and urodynamic evaluation. Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the etiology of the patient's complaints. The goal of the present article is to review clinical and subsidiary diagnosis of urinary incontinence.
Summary
Rev Bras Ginecol Obstet. 2006;28(1):54-62
DOI 10.1590/S0100-72032006000100010
Female lower urinary tract symptoms are nonspecific and a clinical evaluation is required to establish the correct diagnosis. Such evaluation should consist of a structured micturition history or questionnaire, physical examination, micturition diary, pad test, and urodynamic evaluation. Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the etiology of the patient's complaints. The goal of the present article is to review clinical and subsidiary diagnosis of urinary incontinence.
Summary
Rev Bras Ginecol Obstet. 2003;25(7):525-528
DOI 10.1590/S0100-72032003000700010
PURPOSE: to evaluate the results of the use of bovine pericardium in the pubovaginal sling procedure for treatment of stress urinary incontinence. METHODS: a prospective analysis of five patients who underwent pubovaginal sling with the use of bovine pericardium strip for stress urinary incontinence in the "Hospital das Clínicas of UFMG" from October/2001 to December/2001. The mean age was 48.2±11.5 years (33 to 69 years). RESULTS: the mean surgical time was 45±35.3 min and the mean hospital stay was 36±12.4 h (24 to 48 h). Complications in the periperative or immediate postoperative period did not occur. All patients initially presented satisfactory results with normal voiding and without stress incontinence. Postoperative complications occurred in the 5 patients (100%), with dehiscence of the vaginal wound and total expulsion of the strip in 2 patients (40%) and partial expulsion in 3 patients (60%). All patients presented stress urinary incontinence and were submitted to a new sling procedure using the rectus fascia. The patients then progressed without complications and with improvement of urinary continence in 4 patients (80%). CONCLUSIONS: pubovaginal sling with the use of bovine pericardium was associated with high rates of complications. Therefore, its use is not recommended in the treatment of stress urinary incontinence.
Summary
Rev Bras Ginecol Obstet. 2003;25(7):525-528
DOI 10.1590/S0100-72032003000700010
PURPOSE: to evaluate the results of the use of bovine pericardium in the pubovaginal sling procedure for treatment of stress urinary incontinence. METHODS: a prospective analysis of five patients who underwent pubovaginal sling with the use of bovine pericardium strip for stress urinary incontinence in the "Hospital das Clínicas of UFMG" from October/2001 to December/2001. The mean age was 48.2±11.5 years (33 to 69 years). RESULTS: the mean surgical time was 45±35.3 min and the mean hospital stay was 36±12.4 h (24 to 48 h). Complications in the periperative or immediate postoperative period did not occur. All patients initially presented satisfactory results with normal voiding and without stress incontinence. Postoperative complications occurred in the 5 patients (100%), with dehiscence of the vaginal wound and total expulsion of the strip in 2 patients (40%) and partial expulsion in 3 patients (60%). All patients presented stress urinary incontinence and were submitted to a new sling procedure using the rectus fascia. The patients then progressed without complications and with improvement of urinary continence in 4 patients (80%). CONCLUSIONS: pubovaginal sling with the use of bovine pericardium was associated with high rates of complications. Therefore, its use is not recommended in the treatment of stress urinary incontinence.