The urodynamic evaluation of stress urinary incontinence: defining the role.

The aim of this study was to compare the results utilizing "office evaluation" and urodynamics (UDS) in the diagnosis and surgical treatment of SUI. One hundred twenty-eight patients were evaluated; 62 had basic office evaluation consisting of "eyeball CMG" (eCMG) testing and Valsalva supine stress test (VSS). All had multi-channel UDS. The two studies were correlated statistically; 66 patients had voiding phase analysis, recording individual voiding parameters: Max detrusor pressure (Pdet), voiding time (VT), Max uroflow (Qmax), Post-void residual (PVR), and abdominal straining. Each parameter was given a score of 1 if normal and 0 if abnormal, and added to calculate the Voiding Quality Index (VQI) (range 0-5). Individual voiding parameters and the VQI were compared statistically among patients to determine if UDS can predict voiding dysfunction. Determination of DI by eCMG had 88.9% sensitivity and 70.5% specificity. The positive predictive value (PPV) was 66.7%, and the negative predictive value (NPV) was 92.3%. The sensitivity of VSS to detect SUI was 90.6%, with 44.5% specificity. The correlation of a positive VSS with ISD is significantly less in patients with DI on eCMG. The average catheter time was 11.1 days; 50 patients voided within 14 days (NR), and 16 did not (R). DI identified by eCMG is a reliable predictor of DI on UDS. The "VQI" may predict patients at risk for prolonged catheter time after sling. If DI is not present on eCMG, this test may predict storage abnormalities. However, the VQI pressure-flow analysis may offer predictive value to determine post-operative voiding dysfunction.

James Renehan, MD, and J. Christian Winters, MD. New Orleans, LA.