title: Urinary symptoms and urodynamic findings in women with pelvic organ prolapse: is there a correlation? Results of an artificial neural network analysis.
abstract: BACKGROUND
  International official guidelines recommend urodynamic (UDS) evaluation in patients with pelvic organ prolapse (POP). However, the real benefit of this examination is still the subject of heated and controversial debate. Therefore, we aimed to assess the correlation between urinary symptoms and UDS findings in women with POP through the implementation of a sophisticated computer-based technology in the outpatient workup.
  
  
  METHODS
  A prospective cohort study was performed in a single, tertiary, urogynaecologic referral department, enrolling consecutive women seeking care for pelvic floor dysfunctions.
  
  
  METHODS
  Patients underwent clinical and urodynamic evaluation. Data regarding baseline characteristics, symptoms, anatomic, and urodynamic findings were gathered for each patient. Multiple linear regression (MLR) and artificial neural networks (ANNs) were performed to design predicting models.
  
  
  CONCLUSIONS
  A total of 802 women with POP were included. POP quantification stages and baseline data poorly correlated to final UDS findings. Stress urinary incontinence and overactive bladder were both independently associated to each UDS diagnosis, including detrusor overactivity (DO), urodynamic stress incontinence (USI), and mixed urinary incontinence (USI plus DO). Receiver operating characteristic comparison confirmed that ANNs were more accurate than MLR in identifying predictors of UDS diagnosis, but none of these methods could successfully overcome UDS. Case-control studies are needed to confirm our findings.
  
  
  CONCLUSIONS
  Despite the current debate based on the actual value of UDS in women with POP, even the implementation of ANN, a sophisticated computer-based technology, does not permit an accurate diagnosis just on the basis of symptoms or avoiding UDS. Therefore, in women with POP, especially if scheduled for surgery, UDS should be considered as mandatory, since misleading counselling could result in unpleasant unexpected events.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy. mauserati@hotmail.com
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siesto
authors.forename: Elena
authors.initials: E
authors.lastname: Cattoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Braga
authors.forename: Paola
authors.initials: P
authors.lastname: Sorice
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D016571:Neural Networks, Computer; D017773:Pelvic Floor / Q000503:physiopathology*; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D001743:Urinary Bladder / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics