title: Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence?
abstract: OBJECTIVE
  To identify how many patients with symptoms of pure stress urinary incontinence (SUI) do not require any surgical treatment on the basis of urodynamics (UDS) and how many patients still do not require surgery 1 year after UDS. To assess the outcomes of these patients at 12-month follow-up.
  
  
  METHODS
  Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS. Women with USI underwent a Tension Free Vaginal Tape (Obturator) (TVT-O) procedure (Gynecare; Ethicon Inc., Somerville, NJ, USA), whereas women with DO ±/- USI were recommended 24-week antimuscarinic therapy. Follow-up was scheduled at 3 and 12 months. To define subjective outcomes, all patients completed the International Consultation on Incontinence Questionnaire - short form, the Patient Global Impression - Improvement and the Urinary Distress Inventory. Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the Urinary Distress Inventory and a response of 'much better' or 'very much better' on the Patient Global Impression - Improvement.
  
  
  RESULTS
  Of the 263 women with pure SUI, 74.5% had a urodynamic diagnosis of USI, 10.6% had DO, 8% had USI + DO and 6.8% had inconclusive UDS. At 12-month follow-up, 165/181 (91.6%) women in group 1 were considered cured post-TVT-O; in the other groups, 33/67 (49.2%) patients were considered cured simply as a result of taking antimuscarinics; 13 of these 67 patients required TVT-O.
  
  
  CONCLUSIONS
  UDS is able to show that several patients with symptoms of pure SUI present an underlying DO and do not require surgery, even 1 year after UDS. In these patients, antimuscarinic treatment appears to ensure a good rate of cure; thus, UDS could lead to the avoidance of several surgical procedures.
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. mauserati@hotmail.com
authors: Maurizio
authors: M
authors: Serati
authors: Elena
authors: E
authors: Cattoni
authors: Gabriele
authors: G
authors: Siesto
authors: Andrea
authors: A
authors: Braga
authors: Paola
authors: P
authors: Sorice
authors: Simona
authors: S
authors: Cantaluppi
authors: Antonella
authors: A
authors: Cromi
authors: Fabio
authors: F
authors: Ghezzi
authors: Domenico
authors: D
authors: Vitobello
authors: Pierfrancesco
authors: P
authors: Bolis
authors: Stefano
authors: S
authors: Salvatore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003950:Diagnostic Techniques, Urological; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000706:statistics & numerical data
keywords: TVT-O; detrusor overactivity; stress urinary incontinence; urodynamic stress incontinence; urodynamics