Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence?

Objectives 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.Patients and 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 T ension F ree V aginal T ape ( O bturator) ( TVT ‐ O ) procedure ( G ynecare; E thicon I nc., S omerville, 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 I nternational C onsultation on I ncontinence Q uestionnaire – short form, the P atient G lobal I mpression – I mprovement and the U rinary D istress I nventory. Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the U rinary D istress Inventory and a response of ‘much better’ or ‘very much better’ on the P atient G lobal I mpression – I mprovement.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 . A t 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 .ConclusionsUDS 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.