The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.
The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.
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DOI：
10.1016/j.juro.2012.09.050
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发表时间：
2013-01
影响因子：
6.6
通讯作者：
Kusek, John W.
中科院分区：
文献类型：
--
作者：
Sirls, Larry T.;Richter, Holly E.;Litman, Heather J.;Kenton, Kimberly;Lemack, Gary E.;Lukacz, Emily S.;Kraus, Stephen R.;Goldman, Howard B.;Weidner, Alison;Rickey, Leslie;Norton, Peggy;Zyczynski, Halina M.;Kusek, John W.
评价术前尿动力学检查（UDS）对无并发症压力性尿失禁（SUI）手术妇女的诊断、总体治疗计划和结局的影响。术前UDS价值的多中心随机试验的次要分析。医生提供了UDS前后的诊断和总体治疗计划，定义为继续手术、手术类型、手术修改、非手术治疗。通过McNemar检验比较门诊评估（OE）和OE加UDS之间的治疗计划变化和手术结局。OE后随机分配至UDS的315例受试者中有294例具有可评价数据。UDS改变了167名女性的OE诊断（56.8%），减少了OAB-湿型的诊断（41.6%至25.2%，p<0.001），OAB-干燥（31.4%至20.8%，p=0.002）和内源性括约肌功能不全（ISD）（19.4%至12.6%，p=0.003），但增加了排尿功能障碍的诊断（2.2%至11.9%，p<0.001）。在UDS后，医生取消了4/294（1.4%）的手术，改变了13/294（4.4%）的尿失禁程序，并计划改变20/294（6.8%）女性的尿道中段吊带张力（“或多或少阻塞”）。40/294（14%）的非手术治疗计划发生变化。UDS驱动的治疗计划变更与治疗成功无关（OR，0.96（0.41，2.25），p = 0.92），但与紧急UI的术后治疗增加相关（OR 3.23，95% CI 1.46，7.14），p = 0.004）。UDS显著改变了临床诊断和总体治疗计划，但很少影响外科医生取消、改变或修改手术计划的决定。总体治疗计划变更与术后紧迫性UI的治疗增加相关。
To evaluate the influence of pre-operative urodynamic studies (UDS) on diagnoses, global treatment plan and outcomes in women having surgery for uncomplicated stress predominant urinary incontinence (SUI). Secondary analysis from a multicenter, randomized trial of the value of preoperative UDS. Physicians provided pre- and post-UDS diagnoses and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification, non-surgical therapy. Treatment plan changes and surgical outcomes between office evaluation (OE) and OE plus UDS were compared by McNemar’s test. 294 of 315 subjects randomized to UDS after OE had evaluable data. UDS changed the OE diagnoses in167 women (56.8%), decreasing the diagnoses of OAB-wet (41.6% to 25.2%, p<0.001), OAB-dry (31.4% to 20.8%, p=0.002) and intrinsic sphincter deficiency (ISD) (19.4% to 12.6%, p=0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p<0.001). After UDS, physicians cancelled surgery in 4/294 (1.4%), changed the incontinence procedure in 13/294 (4.4%), and planned to modifiy the midurethral sling tension (“more or less obstructive”) in 20/294 women (6.8%). Non-surgical treatment plans changed in 40/294 (14%). UDS driven treatment plan changes were not associated with treatment success (OR, 0.96 (0.41, 2.25), p = 0.92), but were associated with increased postoperative treatment for urge UI (OR 3.23, 95% CI 1.46, 7.14), p = 0.004). UDS significantly changed clinical diagnoses and global treatment plan but infrequently influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for post operative urgency UI.
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影响因子：
2
作者：
Dokmeci, Fulya;Seval, Murat;Gok, Haydar
通讯作者：
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影响因子：
6.6
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影响因子：
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