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Pre‐operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes
Author(s) -
Zimmern Philippe,
Litman Heather,
Nager Charles,
Sirls Larry,
Kraus Stephen R.,
Kenton Kimberly,
Wilson Tracey,
Sutkin Gary,
Siddiqui Nazema,
Vasavada Sandip,
Norton Peggy
Publication year - 2014
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.22398
Subject(s) - medicine , confidence interval , odds ratio , mcnemar's test , overactive bladder , urinary incontinence , logistic regression , urodynamic testing , duloxetine , urology , pathology , statistics , alternative medicine , mathematics
Aims To determine if pre‐operative urodynamic testing (UDS) affects physicians' diagnostic confidence and if physician confidence affects treatment outcomes at 1 year. Methods The Value of Urodynamic Evaluation (ValUE) trial randomized 630 women with predominant stress urinary incontinence (SUI) to office evaluation (OE) or OE plus UDS prior to surgery. After OE, physicians completed a checklist of five clinical diagnoses: SUI, overactive bladder (OAB) wet and dry, voiding dysfunction (VD), and intrinsic sphincter deficiency (ISD), and reported their confidence in each. Responses ranged from 1 to 5 with; 1 = “not very confident (<50%)” to 5 = “extremely confident (95 + %).” After UDS, investigators again rated their confidence in these five clinical diagnoses. Logistic regression analysis correlated physician confidence in diagnosis with treatment success. Results Of 315 women who received OE plus UDS, 294 had complete data. Confidence improved after UDS in patients with baseline SUI (4.52–4.63, P < 0.005), OAB‐wet (3.55–3.75, P < 0.001), OAB‐dry (3.55–3.68 P < 0.005), VD (3.81–3.95, P < 0.005), and suspected ISD (3.63–3.92, P < 0.001). Increased confidence after UDS was not associated with higher odds of treatment success although mean changes in confidence were slightly higher for those who achieved treatment success. Physician diagnoses shifted more from not confident to confident for ISD and OAB‐wet after UDS (McNemar's P ‐value <0.001 for both). Conclusions In women undergoing UDS for predominant SUI, UDS increased physicians' confidence in their clinical diagnoses; however, this did not correlate with treatment success. Neurourol. Urodynam. 33:302–306, 2014 . © 2013 Wiley Periodicals, Inc.