- Email: [email protected]
1700 CLINICAL PREDICTORS AND SIGNIFICANCE OF POSTVOID RESIDUAL VOLUME IN DIABETIC WOMEN
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
1. 2nd ICI 2002 p 345 2. Neurourol Urodyn 19:484 – 486, 2000 Source of Funding: NIH
1698 FEMALE VOIDING NONOGRAM OVERESTIMATES THE INCIDENCE OF OUTLET OBSTRUCTION Peter Rosier*, Utrecht, Netherlands INTRODUCTION AND OBJECTIVES: Both a nomogram (the GautzBlaivas; GBN) as well as standard pressure flow graph (P/Q) analysis can be used to analyze female voiding however no comparative studies exist and standards are lacking. We have tested GBN versus P/Q analysis with effectivity of voiding as comparator. Furthermore we have compared the incidence of bladder outlet obstruction (BOO) as diagnosed with both methods. METHODS: Standard urodynamic testing was performed for non neurologic lower urinary tract dysfunction and symptoms (LUT(D)S) in 289 succesive adult female patients. Predominant LUT(D)S were: stress incont 19%; OAB 30%; mixed (incont) sypmtoms 11%; recurrent UTI 18% Other 20%.) Patients were alowed to void in -normal- sitting position when, at the end of (transuretrhal F8; medium fill; 20o saline filling) cystometry, strong but not uncomfortable desire to void occured. Very unrepresentative (patient reporting) voids are not included in this analysis. Postvoid residual (PVR) was measured before cystometry as well as after P/Q via the F8 catheter. RESULTS: Average (P/Q) voided volume was 375mL (sd 155mL) Qmax 26mL/s (sd 14mL/s) and PVR 47mL (sd 107mL). 18% of the patients had ineffective voiding (emptied% ⱕ80%) On the basis of BGN 28,5% of these patients has BOO and on the basis of standard P/Q analysis 4%. BGN does not classify detrusor (voiding) underactivity but P/Q analysis classifies 39% of these patients as ’weak contraction’. 20% of the patients diagnosed as BOO with either method had ineffective emptying Ineffective emptying is however 4.3 times more likely with a diagnosis ’P/Q analysis BOO’ as compared with 1.1 times, associated with ’BGN-BOO’. Bladder contraction analysis diagnosis of detrusor underactivity is 6.5 times more likely to be associated with ineffective voiding and therefore superior. CONCLUSIONS: The diagnosis of ’bladder outlet obstruction’ had an incidence of almost 30% on the basis of BGN and (only) 4% when standard P/Q limits were aplied in a series of nearly 300 consecutive women. Ineffective female emptying was associated with underactive detrusor which cannot be diagnosed with BGN. We conclude on the basis of the superior association of voiding efficiency with standard P/Q analysis that the BGN is overestimating (the number of female patients) with BOO. We reccomend that standard P/Q analysis and not BGN, is preferable in female patients with LUT(D)S. Source of Funding: None
1699 URODYNAMIC DIFFERENCES BETWEEN DYSFUNCTIONAL VOIDING AND PRIMARY BLADDER NECK OBSTUCTION IN WOMEN Benjamin Brucker*, Eva Fong, Chris Kelly, Sagar Shah, Nirit Rosenblum, Victor Nitti, New York, NY INTRODUCTION AND OBJECTIVES: The two most common causes of “functional” bladder outlet obstruction (BOO) in women are dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO). Traditionally the diagnosis is made by video urodynamics (UDS) which requires simultaneous fluoroscopy. We sought to determine differences in the clinical and UDS presentations of these entities and the value of simultaneous fluoroscopic imaging. METHODS: A retrospective review of a single institution video UDS database (3/03-8/09) was conducted. Patients were excluded if there was no pressure flow study available. A diagnosis of DV was made when there was increased external sphincter activity during
THE JOURNAL OF UROLOGY姞
e683
voiding noted on EMG or fluoroscopy. PBNO was diagnosed when there was a sustained voluntary detrusor contraction with a failure or delay of bladder neck opening on fluoroscopy. Flow patterns were confirmed on non-invasive uroflowmetry. Demographic data, symptoms, and UDS parameters were collected. Comparisons were made utilizing chi squared and two tailed t-tests. RESULTS: From 157 women diagnosed with BOO, DV was diagnosed in 38 and PBNO in 16. Patients with DV were younger than those with PBNO (40.9vs.59.2 yrs,p⬍0.001). UDS findings are summarized below. Patients with DV, had a higher mean Qmax and lower mean PVR. Non-invasive Qmax and PVR confirmed these findings. No significant difference was seen in the maximum Pdet or PdetQmax. There was no difference in the incidence of DO (26.3%DV vs.31.3% PNBO,p⫽.71). EMG showed increase activity during voiding in 79.4% of DV and 14.3% of PBNO (p⬍0.001). Women with DV had clinically had more storage symptoms than PBNO (61%vs.38%,p⫽0.13) and fewer voiding symptoms (53%vs.75%,p⫽.13), but this was not significant. CONCLUSIONS: Clinically women with DV and PBNO have similar presentations, though those with PBNO have poorer emptying. Flow rates and patterns seem to differ between DV and PBNO but voiding pressures are similar. Fluoroscopy proved to be valuable in diagnosing and differentiating the two entities. EMG alone would have given the wrong diagnosis in 20.6% of DV (false negative) and 14.3% of PBNO (false positive).Video UDS are of significant value in diagnosing and differentiating these entities.
Source of Funding: None
1700 CLINICAL PREDICTORS AND SIGNIFICANCE OF POSTVOID RESIDUAL VOLUME IN DIABETIC WOMEN Ayesha Appa*, Jeanette Brown, Leslee Subak, San Francisco, CA; Stephen Van Den Eeden, Oakland, CA; David Thom, Jennifer Creasman, Alison Huang, San Francisco, CA INTRODUCTION AND OBJECTIVES: Measurement of postvoid residual urine volume (PVR) is routinely used to evaluate female diabetic patients with lower urinary tract symptoms (LUTS), but there are few data to indicate which diabetic women are at risk of developing elevated PVR or confirm that PVR elevations contribute to risk of LUTS in this population. METHODS: PVR was measured by bladder ultrasonography in a cross-sectional cohort of 427 middle-aged and older women with diabetes enrolled in an integrated health delivery system in California. Participants completed questionnaires assessing LUTS, including: any weekly urgency incontinence, any weekly stress incontinence, daytime frequency (urinating ⬎8 times during the day), nocturia (awakening ⬎2 times to urinate at night), and obstructive voiding (defined as a positive response to at least one of 4 obstructive voiding questions on the AUA Symptom Index). Diabetic end-organ complications such as heart disease, stroke, and neuropathy were assessed by interviewer-administered questionnaires, while glycemic control and kidney function were
e684
THE JOURNAL OF UROLOGY姞
assessed by serum Hemoglobin A1C (HbA1c) and creatinine. Logistic regression models examined associations between markers of diabetes severity and elevations in PVR, as well as relationships between PVR elevations and urinary symptoms. RESULTS: Seventy-five percent of women [n⫽358] had a PVR of 0-49, 13% [n⫽57] had a PVR of 50-99, and 12% [n⫽52] had a PVR ⱖ100 mL. In multivariable models, poorer glycemic control was associated with an only increased likelihood of PVR ⱖ100 mL vs ⬍50 mL (OR 1.30, CI 1.06-1.59 per 1.0-unit increase in HbA1c). Approximately 19% [n⫽60] of women with a PVR ⬍50 mL, 25% [n⫽14] of women with a PVR of 50-99, and 31% [n⫽16] of those with PVR ⱖ100 mL had at least one urinary symptom. In multivariable analysis, diabetic women with PVR ⱖ100 were more likely to report weekly urgency incontinence (OR⫽2.18, CI⫽1.08-4.41) and obstructive voiding symptoms (OR⫽ 2.47, CI⫽1.18-5.17) than those with PVR ⬍50 mL, but no significant associations between elevated PVR and other LUTS were detected. CONCLUSIONS: Among middle-aged and older women with diabetes, poor glycemic control is associated with a PVR of 100 mL or greater. Higher PVR may be associated with increased risk of urgency incontinence and obstructive voiding in this population. However, nearly 20% of diabetic women with PVR⬍50 report one or more LUTS, and the majority of diabetic women with PVR ⱖ100 mL report no symptoms. These findings suggest that decreased bladder emptying is only one possible contributor to lower urinary tract symptoms in diabetic women. Source of Funding: UCSF School of Medicine Dean’s Summer Research Fellowship
1701 TEN YEARS FOLLOW UP OF THE RETRO-PUBIC TENSION FREE VAGINAL TAPE: PREDICTORS FOR LONG TERM SUCCESS Asnat Groutz*, Gila Rosen, Aviad Cohen, Ronen Gold, Joseph Lessing, David Gordon, Tel Aviv, Israel INTRODUCTION AND OBJECTIVES: Surgical interventions for stress urinary incontinence (SUI) are usually undertaken during midlife. However, people all over the world are now living longer. It is therefore important to assess outcome results of these procedures in later life. Unfortunately, such studies are scarcely available: only 2 Scandinavian studies reported 11 years results of tension-free vaginal tape (TVT). The present study was conducted to assess the 10 years outcome results of the retro-pubic TVT and to explore possible predictors for long-term success. METHODS: 60 consecutive women who underwent retro-pubic TVT for urodynamically-confirmed overt SUI during the year 2000 were enrolled. Urodynamic evaluation was undertaken before and after surgery. All procedures were undertaken by two experienced surgeons. Exclusion criteria included concomitant anterior and/or apical pelvic organ prolapse repair, or cases of urodynamic occult SUI. Ten years outcome results were assessed by a structured telephone interview conducted by a research nurse. Women were asked regarding their global satisfaction (cure, improvement, failure); existence and severity of lower urinary tract symptoms, or any other adverse outcomes; further therapies (surgery, medications, others); interest in further evaluation and treatment; and whether or not they will recommend such a surgery to a friend. RESULTS: 52 (87%) women (mean age at surgery 62.4⫹9.3 years) were available for 10 years follow-up. Preoperatively, 15 (29%) women had previously undergone hysterectomy, 5 (10%) underwent anti-incontinence surgery, and 28 (54%) had concomitant urge urinary incontinence (UUI). 10 years postoperatively, 34 (65%) women considered themselves as cured, 6 (12%) as improved, and 12 (23%) thought surgery had failed. 11 (21%) women complained of SUI, 22 (42%) had UUI (9 of whom had de novo UUI), and 8 (15%) had recurrent UTIs. Two (4%) women underwent repeated TVT. In addition to persistent SUI, failure cases were more likely to have intraoperative complications and early postoperative morbidity, postoperative UUI, and recurrent UTIs (Table).
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
CONCLUSIONS: Subjective long-term outcome results of the retro-pubic TVT are less favorable than previously reported and patients should be advised accordingly. Mean⫹SD (%) Age at surgery
Failure N⫽12 (23%) 65⫹7.2
Cure/Improvement N⫽40 (77%) 61.6⫹9.7
Parity
3.6⫹1.7
2.6⫹1.1
Preoperative UUI
8 (67%)
20 (50%)
Bladder perforation
3 (25%)
0
Postoperative catheterization 48h
5 (42%)
4 (10%)
SUI at 10y F/U
9 (75%)
2 (5%)
UUI at 10y F/U
7 (58%)
15 (38%)
Rec UTIs Additional surgery
5 (42%) Urethrolysis⫹TVT-O
3 (8%) TVT-O; APC
Source of Funding: None
1702 PATIENT-REPORTED OUTCOMES FOLLOWING SURGERY FOR STRESS URINARY INCONTINENCE DIFFER DEPENDENT ON QUESTIONNAIRE Jason Kim*, Gjanje Smith, Alvaro Lucioni, Fred Govier, Kathleen Kobashi, Seattle, WA INTRODUCTION AND OBJECTIVES: The assessment of outcomes following medical or surgical treatment of incontinence remains difficult. Currently there is no accepted definition of success or cure, which has made comparison of the reported results in the literature nearly impossible. The purpose of this study is to demonstrate the variability in patient-reported outcomes of stress urinary incontinence (SUI) procedures from mailed post-operative questionnaires. METHODS: We examined the results of patient-reported outcomes following anti-incontinence surgery. Post-operative questionnaires, including the Urogenital Distress Inventory- Short Form (UDI-6) and the Incontinence Questionnaire (IQ), were mailed to all patients at approximately yearly intervals to assess outcomes. Both questionnaires are validated and had specific items assessing SUI (table 1, UDI-6 question 3 and IQ question 2). We compared the results of these similarly worded questions to determine the variability of the results between the 2 questionnaires. RESULTS: We identified 563 patients who had anti-incontinence procedures (autologous fascial slings, bone-anchored slings, transobturator mid-urethral slings, and retropubic mid-urethral slings) with at least 12 month follow-up. 519 of 563 patients (92.2%) answered the SUI items described above using both instruments. Average follow-up was 44.2 months. There was a siginificant difference in the percentage of patients who reported no SUI following sling surgery using the UDI-6 vs. the IQ (43.6% (224/519) and 31.6% (164/519), respectively, ⫼2⬍0.00001). Of the 164 patients who reported being dry by IQ criteria, 98.8% of the patients answered that they were free of SUI by UDI-6 criteria. Conversely, of the 224 patients who reported no SUI after sling surgery using the UDI-6 criteria, only 72.3% of those patients answered that they were free of SUI by IQ criteria. CONCLUSIONS: Even very similarly worded questions attempting to assess degree of patient-reported SUI following sling surgery have tremendous variability. Efforts to standardize reported outcomes following anti-incontinence surgery have previously been attempted. The results of this study strengthen the argument for the need of standardization of results.
1. 2nd ICI 2002 p 345 2. Neurourol Urodyn 19:484 – 486, 2000 Source of Funding: NIH
1698 FEMALE VOIDING NONOGRAM OVERESTIMATES THE INCIDENCE OF OUTLET OBSTRUCTION Peter Rosier*, Utrecht, Netherlands INTRODUCTION AND OBJECTIVES: Both a nomogram (the GautzBlaivas; GBN) as well as standard pressure flow graph (P/Q) analysis can be used to analyze female voiding however no comparative studies exist and standards are lacking. We have tested GBN versus P/Q analysis with effectivity of voiding as comparator. Furthermore we have compared the incidence of bladder outlet obstruction (BOO) as diagnosed with both methods. METHODS: Standard urodynamic testing was performed for non neurologic lower urinary tract dysfunction and symptoms (LUT(D)S) in 289 succesive adult female patients. Predominant LUT(D)S were: stress incont 19%; OAB 30%; mixed (incont) sypmtoms 11%; recurrent UTI 18% Other 20%.) Patients were alowed to void in -normal- sitting position when, at the end of (transuretrhal F8; medium fill; 20o saline filling) cystometry, strong but not uncomfortable desire to void occured. Very unrepresentative (patient reporting) voids are not included in this analysis. Postvoid residual (PVR) was measured before cystometry as well as after P/Q via the F8 catheter. RESULTS: Average (P/Q) voided volume was 375mL (sd 155mL) Qmax 26mL/s (sd 14mL/s) and PVR 47mL (sd 107mL). 18% of the patients had ineffective voiding (emptied% ⱕ80%) On the basis of BGN 28,5% of these patients has BOO and on the basis of standard P/Q analysis 4%. BGN does not classify detrusor (voiding) underactivity but P/Q analysis classifies 39% of these patients as ’weak contraction’. 20% of the patients diagnosed as BOO with either method had ineffective emptying Ineffective emptying is however 4.3 times more likely with a diagnosis ’P/Q analysis BOO’ as compared with 1.1 times, associated with ’BGN-BOO’. Bladder contraction analysis diagnosis of detrusor underactivity is 6.5 times more likely to be associated with ineffective voiding and therefore superior. CONCLUSIONS: The diagnosis of ’bladder outlet obstruction’ had an incidence of almost 30% on the basis of BGN and (only) 4% when standard P/Q limits were aplied in a series of nearly 300 consecutive women. Ineffective female emptying was associated with underactive detrusor which cannot be diagnosed with BGN. We conclude on the basis of the superior association of voiding efficiency with standard P/Q analysis that the BGN is overestimating (the number of female patients) with BOO. We reccomend that standard P/Q analysis and not BGN, is preferable in female patients with LUT(D)S. Source of Funding: None
1699 URODYNAMIC DIFFERENCES BETWEEN DYSFUNCTIONAL VOIDING AND PRIMARY BLADDER NECK OBSTUCTION IN WOMEN Benjamin Brucker*, Eva Fong, Chris Kelly, Sagar Shah, Nirit Rosenblum, Victor Nitti, New York, NY INTRODUCTION AND OBJECTIVES: The two most common causes of “functional” bladder outlet obstruction (BOO) in women are dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO). Traditionally the diagnosis is made by video urodynamics (UDS) which requires simultaneous fluoroscopy. We sought to determine differences in the clinical and UDS presentations of these entities and the value of simultaneous fluoroscopic imaging. METHODS: A retrospective review of a single institution video UDS database (3/03-8/09) was conducted. Patients were excluded if there was no pressure flow study available. A diagnosis of DV was made when there was increased external sphincter activity during
THE JOURNAL OF UROLOGY姞
e683
voiding noted on EMG or fluoroscopy. PBNO was diagnosed when there was a sustained voluntary detrusor contraction with a failure or delay of bladder neck opening on fluoroscopy. Flow patterns were confirmed on non-invasive uroflowmetry. Demographic data, symptoms, and UDS parameters were collected. Comparisons were made utilizing chi squared and two tailed t-tests. RESULTS: From 157 women diagnosed with BOO, DV was diagnosed in 38 and PBNO in 16. Patients with DV were younger than those with PBNO (40.9vs.59.2 yrs,p⬍0.001). UDS findings are summarized below. Patients with DV, had a higher mean Qmax and lower mean PVR. Non-invasive Qmax and PVR confirmed these findings. No significant difference was seen in the maximum Pdet or PdetQmax. There was no difference in the incidence of DO (26.3%DV vs.31.3% PNBO,p⫽.71). EMG showed increase activity during voiding in 79.4% of DV and 14.3% of PBNO (p⬍0.001). Women with DV had clinically had more storage symptoms than PBNO (61%vs.38%,p⫽0.13) and fewer voiding symptoms (53%vs.75%,p⫽.13), but this was not significant. CONCLUSIONS: Clinically women with DV and PBNO have similar presentations, though those with PBNO have poorer emptying. Flow rates and patterns seem to differ between DV and PBNO but voiding pressures are similar. Fluoroscopy proved to be valuable in diagnosing and differentiating the two entities. EMG alone would have given the wrong diagnosis in 20.6% of DV (false negative) and 14.3% of PBNO (false positive).Video UDS are of significant value in diagnosing and differentiating these entities.
Source of Funding: None
1700 CLINICAL PREDICTORS AND SIGNIFICANCE OF POSTVOID RESIDUAL VOLUME IN DIABETIC WOMEN Ayesha Appa*, Jeanette Brown, Leslee Subak, San Francisco, CA; Stephen Van Den Eeden, Oakland, CA; David Thom, Jennifer Creasman, Alison Huang, San Francisco, CA INTRODUCTION AND OBJECTIVES: Measurement of postvoid residual urine volume (PVR) is routinely used to evaluate female diabetic patients with lower urinary tract symptoms (LUTS), but there are few data to indicate which diabetic women are at risk of developing elevated PVR or confirm that PVR elevations contribute to risk of LUTS in this population. METHODS: PVR was measured by bladder ultrasonography in a cross-sectional cohort of 427 middle-aged and older women with diabetes enrolled in an integrated health delivery system in California. Participants completed questionnaires assessing LUTS, including: any weekly urgency incontinence, any weekly stress incontinence, daytime frequency (urinating ⬎8 times during the day), nocturia (awakening ⬎2 times to urinate at night), and obstructive voiding (defined as a positive response to at least one of 4 obstructive voiding questions on the AUA Symptom Index). Diabetic end-organ complications such as heart disease, stroke, and neuropathy were assessed by interviewer-administered questionnaires, while glycemic control and kidney function were
e684
THE JOURNAL OF UROLOGY姞
assessed by serum Hemoglobin A1C (HbA1c) and creatinine. Logistic regression models examined associations between markers of diabetes severity and elevations in PVR, as well as relationships between PVR elevations and urinary symptoms. RESULTS: Seventy-five percent of women [n⫽358] had a PVR of 0-49, 13% [n⫽57] had a PVR of 50-99, and 12% [n⫽52] had a PVR ⱖ100 mL. In multivariable models, poorer glycemic control was associated with an only increased likelihood of PVR ⱖ100 mL vs ⬍50 mL (OR 1.30, CI 1.06-1.59 per 1.0-unit increase in HbA1c). Approximately 19% [n⫽60] of women with a PVR ⬍50 mL, 25% [n⫽14] of women with a PVR of 50-99, and 31% [n⫽16] of those with PVR ⱖ100 mL had at least one urinary symptom. In multivariable analysis, diabetic women with PVR ⱖ100 were more likely to report weekly urgency incontinence (OR⫽2.18, CI⫽1.08-4.41) and obstructive voiding symptoms (OR⫽ 2.47, CI⫽1.18-5.17) than those with PVR ⬍50 mL, but no significant associations between elevated PVR and other LUTS were detected. CONCLUSIONS: Among middle-aged and older women with diabetes, poor glycemic control is associated with a PVR of 100 mL or greater. Higher PVR may be associated with increased risk of urgency incontinence and obstructive voiding in this population. However, nearly 20% of diabetic women with PVR⬍50 report one or more LUTS, and the majority of diabetic women with PVR ⱖ100 mL report no symptoms. These findings suggest that decreased bladder emptying is only one possible contributor to lower urinary tract symptoms in diabetic women. Source of Funding: UCSF School of Medicine Dean’s Summer Research Fellowship
1701 TEN YEARS FOLLOW UP OF THE RETRO-PUBIC TENSION FREE VAGINAL TAPE: PREDICTORS FOR LONG TERM SUCCESS Asnat Groutz*, Gila Rosen, Aviad Cohen, Ronen Gold, Joseph Lessing, David Gordon, Tel Aviv, Israel INTRODUCTION AND OBJECTIVES: Surgical interventions for stress urinary incontinence (SUI) are usually undertaken during midlife. However, people all over the world are now living longer. It is therefore important to assess outcome results of these procedures in later life. Unfortunately, such studies are scarcely available: only 2 Scandinavian studies reported 11 years results of tension-free vaginal tape (TVT). The present study was conducted to assess the 10 years outcome results of the retro-pubic TVT and to explore possible predictors for long-term success. METHODS: 60 consecutive women who underwent retro-pubic TVT for urodynamically-confirmed overt SUI during the year 2000 were enrolled. Urodynamic evaluation was undertaken before and after surgery. All procedures were undertaken by two experienced surgeons. Exclusion criteria included concomitant anterior and/or apical pelvic organ prolapse repair, or cases of urodynamic occult SUI. Ten years outcome results were assessed by a structured telephone interview conducted by a research nurse. Women were asked regarding their global satisfaction (cure, improvement, failure); existence and severity of lower urinary tract symptoms, or any other adverse outcomes; further therapies (surgery, medications, others); interest in further evaluation and treatment; and whether or not they will recommend such a surgery to a friend. RESULTS: 52 (87%) women (mean age at surgery 62.4⫹9.3 years) were available for 10 years follow-up. Preoperatively, 15 (29%) women had previously undergone hysterectomy, 5 (10%) underwent anti-incontinence surgery, and 28 (54%) had concomitant urge urinary incontinence (UUI). 10 years postoperatively, 34 (65%) women considered themselves as cured, 6 (12%) as improved, and 12 (23%) thought surgery had failed. 11 (21%) women complained of SUI, 22 (42%) had UUI (9 of whom had de novo UUI), and 8 (15%) had recurrent UTIs. Two (4%) women underwent repeated TVT. In addition to persistent SUI, failure cases were more likely to have intraoperative complications and early postoperative morbidity, postoperative UUI, and recurrent UTIs (Table).
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
CONCLUSIONS: Subjective long-term outcome results of the retro-pubic TVT are less favorable than previously reported and patients should be advised accordingly. Mean⫹SD (%) Age at surgery
Failure N⫽12 (23%) 65⫹7.2
Cure/Improvement N⫽40 (77%) 61.6⫹9.7
Parity
3.6⫹1.7
2.6⫹1.1
Preoperative UUI
8 (67%)
20 (50%)
Bladder perforation
3 (25%)
0
Postoperative catheterization 48h
5 (42%)
4 (10%)
SUI at 10y F/U
9 (75%)
2 (5%)
UUI at 10y F/U
7 (58%)
15 (38%)
Rec UTIs Additional surgery
5 (42%) Urethrolysis⫹TVT-O
3 (8%) TVT-O; APC
Source of Funding: None
1702 PATIENT-REPORTED OUTCOMES FOLLOWING SURGERY FOR STRESS URINARY INCONTINENCE DIFFER DEPENDENT ON QUESTIONNAIRE Jason Kim*, Gjanje Smith, Alvaro Lucioni, Fred Govier, Kathleen Kobashi, Seattle, WA INTRODUCTION AND OBJECTIVES: The assessment of outcomes following medical or surgical treatment of incontinence remains difficult. Currently there is no accepted definition of success or cure, which has made comparison of the reported results in the literature nearly impossible. The purpose of this study is to demonstrate the variability in patient-reported outcomes of stress urinary incontinence (SUI) procedures from mailed post-operative questionnaires. METHODS: We examined the results of patient-reported outcomes following anti-incontinence surgery. Post-operative questionnaires, including the Urogenital Distress Inventory- Short Form (UDI-6) and the Incontinence Questionnaire (IQ), were mailed to all patients at approximately yearly intervals to assess outcomes. Both questionnaires are validated and had specific items assessing SUI (table 1, UDI-6 question 3 and IQ question 2). We compared the results of these similarly worded questions to determine the variability of the results between the 2 questionnaires. RESULTS: We identified 563 patients who had anti-incontinence procedures (autologous fascial slings, bone-anchored slings, transobturator mid-urethral slings, and retropubic mid-urethral slings) with at least 12 month follow-up. 519 of 563 patients (92.2%) answered the SUI items described above using both instruments. Average follow-up was 44.2 months. There was a siginificant difference in the percentage of patients who reported no SUI following sling surgery using the UDI-6 vs. the IQ (43.6% (224/519) and 31.6% (164/519), respectively, ⫼2⬍0.00001). Of the 164 patients who reported being dry by IQ criteria, 98.8% of the patients answered that they were free of SUI by UDI-6 criteria. Conversely, of the 224 patients who reported no SUI after sling surgery using the UDI-6 criteria, only 72.3% of those patients answered that they were free of SUI by IQ criteria. CONCLUSIONS: Even very similarly worded questions attempting to assess degree of patient-reported SUI following sling surgery have tremendous variability. Efforts to standardize reported outcomes following anti-incontinence surgery have previously been attempted. The results of this study strengthen the argument for the need of standardization of results.